Cost & Affordability

Cost and affordability pressures are converging on VBC strategy: KFF estimates the House-passed One Big Beautiful Bill Act would cut federal Medicaid spending by $793B over ten years and reduce Medicaid enrollment by 10.3M by 2034, including 1.3M dual-eligible Medicare beneficiaries—raising uncompensated care, risk-adjustment, and total-cost-of-care exposure for ACOs, Medicare Advantage plans, and safety-net systems (KFF). At the same time, hospital leaders are bracing for material financial fallout from Medicaid cuts, while payment-model operators are being pushed to manage upstream cost signals—such as preoperative acute-care spending in bundled payments—and integrate pharmacy performance into VBC financial management as medication adherence and drug spend become more central to affordability. Physician skepticism that insurer prior authorization pledges will produce meaningful change also signals a continued administrative-friction risk for value-based care organizations trying to reduce avoidable utilization without worsening access.