May 15, 2025

CMMI’s new approach focuses on promoting the prevention of illness and helping patients manage chronic conditions; using data and technology to help beneficiaries reach their health goals; and ensuring independent and rural providers can participant in payment models to support competition and choice for healthcare services. New model designs could require all alternative payment models to involve downside risk, pushing more beneficiaries into arrangements with financial risk for providers.

According to a Leerink Partners analyst, the transition wasn’t all that surprising in light of the recent business developments and deterioration in investor trust over the past few months. Hemsley sees continued opportunity for United Health and hopes to return to their long-term growth objective of 13-16 percent.

Evidence that pharmacy benefit managers (PBMs) contribute to rising drug costs, restrict patient access to medications, and drive independent pharmacies out of business has renewed congressional interest in reforming the PBM industry. Congress was prepared to pass significant PBM reform late last year, but key provisions were ultimately removed from the bill following public criticism from Elon Musk.

CMS projects the rule could save taxpayers over $30 billion across five years, but providers—many of whom already operate at a loss when serving Medicaid patients—warn that the loss of supplemental payments could deepen financial strain. Dr. Oz has voiced support for the proposal, arguing it ensures federal Medicaid dollars are directed where they’re needed most: to deliver care for vulnerable Americans who depend on the program.

The Justice Department's healthcare-fraud unit is probing potential misconduct, following a series of investigations and high-profile events that have driven the company’s stock down nearly 40% this year.