CENTER UPDATE | December 2025

In this Issue:

  • Approaches to Reducing Low-Value Care in Traditional Medicare
  • Fee-for-Service Models Linked to Higher Odds of Low-Value Surgeries
  • VA Clinicians Identify Key Drivers and Approaches to Low-Value Care
  • CMS Launches MAHA ELEVATE Model
  • CMMI ACCESS Model Aims to Expand Tech-Enabled Chronic Care
  • New Fee Schedule Rule in Medicare Expands Focus on Chronic Disease Prevention
  • HHS Proposes Updates to Medicare Drug Cost-Sharing and Plan Ratings
  • Post Delivery Changes May Threaten Prescription Drug Access
  • Most Americans Are Happy With Their 2026 Plan Choices
  • High Deductible Plans Undermine Diabetes Care for Patients
  • Insurers Plan to Maintain No-Cost Coverage for Hepatitis B Vaccine
  • Simplifying Health Plan Choices Could Improve Coverage Outcomes

Approaches to Reducing Low-Value Care in Traditional Medicare

A Health Affairs Forefront analysis outlines how traditional Medicare could reduce low- and no-value care through targeted utilization management and alternative payment models. The authors note that clinical uncertainty limits algorithmic decision-making, requiring careful focus on clearly inappropriate services. They argue that combining utilization management with payment reforms is critical to slowing spending growth while preserving high-value care.

Fee-for-Service Models Linked to Higher Odds of Low-Value Surgeries

A new study found that patients enrolled in fee-for-service (FFS) Medicare models had higher odds of receiving low-value surgical procedures compared with those in value-based payment models. The analysis showed that FFS alignment was associated with increased use of surgeries considered low clinical value, even after adjusting for patient and clinical factors. These findings suggest that payment model design may influence the delivery of services that offer limited benefit to patients.

VA Clinicians Identify Key Drivers and Approaches to Low-Value Care

A qualitative study of 65 clinicians across 46 VA medical centers found that environmental constraints, social pressures, and beliefs about consequences contribute to the persistence of low-value care. Practical strategies from frontline providers to reduce unnecessary services included improving access and quality, enhancing electronic health records, spreading best practices, and strengthening a systemwide culture of value.

CMS Launches MAHA ELEVATE Model to Test Lifestyle-Based Medicare

CMS has launched the MAHA ELEVATE Model to support up to 30 pilot projects that integrate lifestyle and evidence-based functional medicine into traditional Medicare to prevent or slow chronic disease. Selected organizations will receive about $3 million over 3 years to evaluate impacts on costs, quality, and health outcomes, with the first cohort beginning September 1, 2026.

CMMI ACCESS Model Aims to Expand Tech-Enabled Chronic Care

CMMI has launched the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a voluntary 10-year program supporting technology-enabled treatment for conditions such as diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. The model provides stable, outcome-aligned payments to help providers integrate tools like digital therapeutics and remote monitoring. ACCESS also waives copayments for included services and allows referring providers to earn co-management payments.

New Fee Schedule Rule in Medicare Expands Focus on Chronic Disease Prevention

The IRS has issued new guidance under the One Big Beautiful Bill that expands Health Savings Account (HSA) eligibility to people enrolled in Bronze and Catastrophic Marketplace plans and those in direct primary care arrangements beginning January 1, 2026. This change allows more Americans to access HSAs’ triple tax benefits, rather than limiting eligibility to high-deductible health planenrollees. The agency is seeking public comment on the new rules as implementation moves forward.

HHS Proposes Updates to Medicare Drug Cost-Sharing and Plan Ratings

DHHS has proposed a rule that would formalize recent changes to Part D prescription drug cost-sharing and update how quality “star ratings” are calculated for Medicare Advantage plans. The proposed rule would implement provisions of the Inflation Reduction Act affecting Part D benefits starting in 2027, including cost-sharing updates that followed broader drug pricing reforms. It also would revise the star ratings methodology to better reward quality and innovation, potentially affecting bonuses and plan marketing privileges.

Post Delivery Changes May Threaten Prescription Drug Access

A new analysis warns that proposed U.S. Postal Service changes could delay access to prescription medications, especially for rural residents who depend on mail-order pharmacies. About 6% of diabetes prescriptions are filled by mail, and 3.7 million Medicare-eligible Americans live in areas with limited pharmacy access and high reliance on USPS delivery. The study raises concerns that shifting to regional processing hubs may slow deliveries and undermine chronic disease management for vulnerable populations.

Most Americans Are Happy With Their 2026 Plan Choices

A new eHealth survey finds that 77% of Americans who reviewed their 2026 health insurance options feel good about the coverage available to them, with the highest satisfaction among Medicare beneficiaries (86%) and those with employer plans. Despite this overall satisfaction, more than half of ACA enrollees were surprised by high monthly premiums during open enrollment. The survey also shows interest in discounted GLP-1 medications and AI tools to help select plans, while many remain optimistic that enhanced ACA subsidies will be extended by Congress.

High Deductible Plans Undermine Diabetes Care for Patients

A recent report highlights how high deductible health plans are forcing patients with diabetes to cut corners on care, such as switching to less effective medications and foregoing monitoring tools, because of an annual $4,000 out-of-pocket deductible. These financial barriers contributed to worsening blood sugar control for some patients, while broader trends show about half of private plans now have high deductibles. The article notes that people with chronic conditions are particularly vulnerable to complications and financial strain under such plans as deductibles rise and ACA subsidies expire.

Insurers Plan to Maintain No-Cost Coverage for Hepatitis B Vaccine

After a CDC advisory panel voted to limit universal newborn hepatitis B vaccination, major insurers announced they will continue covering the vaccine at no cost through 2026. The new guidance recommends the birth dose only when a parent’s hepatitis B status is positive or unknown. Pediatric experts warn the shift could reduce newborn protection, but insurers say access will remain unchanged for now.

Simplifying Health Plan Choices Could Improve Coverage Outcomes

An issue brief finds that the complexity of ACA Marketplace plan choices creates confusion, reduces enrollment, and may lead consumers to pick less cost-effective coverage. The analysis shows that reducing the number of plan options, enhancing decision support tools, and standardizing benefit information can help consumers make better choices. Simplified choice architectures have been associated with higher enrollment in more generous plans and lower out-of-pocket costs.

2026 Virtual V-BID Summit

Employing Innovative Technology to Enhance Quality & Lower Spending

March 11, 2026 | 12 - 4PM EST

Sponsorship Opportunities

Missed an Issue of Our Newsletter?

You can always find previous editions of our weekly newsletters on our website here.