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<td><span style="font-family:Helvetica, sans-serif; font-size:20px;font-weight:bold;">Health Tech | Fierce Healthcare</span></td>
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<td><a href="https://www.fiercehealthcare.com/payers/gao-audit-outlining-cmmis-limited-model-scale-ups-draws-more-republican-scrutiny" style="font-family:Helvetica, sans-serif; letter-spacing:-1px;margin:0;padding:0 0 2px;font-weight: bold;font-size: 19px;line-height: 20px;color:#222;">GAO audit outlines CMMI's limited scale-ups, draws new criticism</a>
<div style="font-family:Helvetica, sans-serif; text-align:left;color:#999;font-size:11px;font-weight:bold;line-height:15px;">Apr 3rd 2026, 13:45</div>
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<p><div class="col content" morss_own_score="4.825448613376835" morss_score="48.37430027000334">
<p>A Government Accountability Office audit of the Center for Medicare and Medicaid Innovation Center’s historical spending and the outcomes of its models has reignited lawmaker calls to increase scrutiny over its work. </p>
<p>The <a href="https://www.gao.gov/products/gao-26-107953">report</a>, prompted by a 2024 request from House Budget Committee leaders and published last week, outlined 70 delivery and payment models that CMMI developed and tested between 2011 and 2024. </p>
<p>As of January 2025, 24 of those remained in active testing and just four had been scaled for nationwide implementation, though GAO noted that some elements of those models have been incorporated into Medicare and that iterative successor models are also being tested. </p>
<p>Additionally, the audit outlined a total of $11.4 billion was obligated to CMMI during that 14-year window, with obligations peaking at $1.3 billion in FY2015 and dipping to $789 million in FY2024. The reduction was attributed by CMMI to a reduction in the number of models being tested and, to a lesser extent, changes in how some of the center’s activities are tracked and reported. </p>
<p>“Specifically, the Innovation Center has centralized common model functions to be more cost efficient, according to officials,” GAO wrote in the report. “For example, officials noted that the agency created centralized resources to support certain activities—like information technology and quality measure development—which simplified contract administration.”</p>
<p>CMMI was established under the 2010’s Affordable Care Act, which obligated $10 billion per decade for the center to pursue federal healthcare spending reductions and quality improvements. </p>
<p>The new audit’s report of four nationally scaled models adds fuel to the fire for the CMMI’s critics, whose <a href="https://www.fiercehealthcare.com/regulatory/lawmakers-demand-answers-cms-innovation-center-failing-generate-savings-healthcare">calls for reform</a> are backstopped by <a href="https://www.fiercehealthcare.com/payers/report-cmmi-has-raised-federal-spending-not-lowered-it">a 2023 Congressional Budget Office (CBO) assessment</a> that found CMMI increased indirect spending by $5.4 billion during its first decade (0.1% of net Medicare spending during that time). CBO initially predicted that CMMI would yield savings and, in a subsequent projection, estimated that the center would increase federal spending by $1.3 billion from FY2021 to FY2030. </p>
<p>In a statement released this week, Rep. Jodey Arrington, R-Texas, who chairs the House Budget Committee, said CMMI has failed on both its quality and savings charges. </p>
<p>"A [5.7%] success rate isn’t innovation—it’s failure,” he said. “And with our national debt barreling past $39 trillion, we can’t afford programs that promise savings but consistently come up short.”</p>
<p>Arrington noted that the center’s mission “is too important to abandon,” and that the effort would be better executed under the Trump administration. </p>
<p>“I’m encouraged by Secretary Kennedy’s and CMS Administrator Oz’s commitment to rooting out waste, fraud and abuse and ensuring the Innovation Center finally delivers on its promise—for patients and for taxpayers."</p>
<p>The early days of the new administration <a href="https://www.fiercehealthcare.com/regulatory/cmmi-cut-short-payment-models-estimates-750m-savings">brought sweeping change for CMMI</a>, with officials promising a “data-driven review” of all current models and the premature conclusion of several by the end of 2025, citing hundreds of millions in expected cost savings. Among the new pilot programs it has floated since are the <a href="https://www.fiercehealthcare.com/digital-health/payers-sign-pledge-join-cmmi-access-model">Medicare Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model</a>, which promotes the use of new technology to treat chronic diseases; the <a href="https://www.fiercehealthcare.com/payers/new-cmmi-model-injects-enhanced-technologies-medicare-prior-authorization-limit-fraud">Wasteful and Inappropriate Service Reduction (WISeR) model</a>, which uses <a href="https://www.fiercehealthcare.com/regulatory/nonprofit-electronic-frontier-foundation-sues-cms-over-ai-prior-authorization">yet-to-be-detailed</a> technologies to introduce prior authorization into traditional Medicare; and <a href="https://www.fiercehealthcare.com/regulatory/cmmi-proposes-new-models-lower-drug-prices-international-rates-medicare-parts-b-d">a pair</a> that will factor international prices into inflationary rebates drug manufacturers must pay to Medicare Part B and Part D for certain products. </p>
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<td><a href="https://www.fiercehealthcare.com/telehealth/novo-nordisk-launches-first-and-only-wegovy-subscription-program" style="font-family:Helvetica, sans-serif; letter-spacing:-1px;margin:0;padding:0 0 2px;font-weight: bold;font-size: 19px;line-height: 20px;color:#222;">Novo Nordisk rolls out discounted subscription plan for Wegovy</a>
<div style="font-family:Helvetica, sans-serif; text-align:left;color:#999;font-size:11px;font-weight:bold;line-height:15px;">Apr 3rd 2026, 13:45</div>
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<p><div class="col content" morss_own_score="5.359999999999999" morss_score="42.75576217583807">
<p>Novo Nordisk rolled out a multi-month subscription plan for Wegovy, the “first and only” program of its kind that the manufacturer says could save users up to $1,200 annually.</p>
<p>The new program aims to lower patients' cost uncertainty to help people stay on the FDA-approved GLP-1 obesity treatment. Eligible self-pay patients can enroll through select telehealth providers at a “lower, predictable monthly price,” the company said in a <a href="https://www.prnewswire.com/news-releases/novo-nordisk-launches-first-and-only-multi-month-subscription-program-for-fda-approved-wegovy-offering-savings-of-up-to-1-200year-302729943.html">press release</a>.</p>
<p>“By providing predictable monthly pricing, multi-month options, and access through trusted telehealth providers, this program aims to support a more manageable way for people to stay on treatment and focus on achieving meaningful, sustainable weight loss outcomes,” said Ed Cinca, Novo Nordisk senior vice president of marketing and patient solutions, in the announcement. </p>
<p>The new subscription plan comes as Novo Nordisk battles intense competition from Eli Lilly's obesity treatments as well as versions of the drugs sold through compounding pharmacies. While Novo was first to market with both injectable Wegovy and its Wegovy pill, the company has subsequently ceded its superior obesity market share in the U.S. to Lilly, Fierce Pharma <a href="https://www.fiercepharma.com/pharma/lilly-answers-novos-glp-1-pill-highly-anticipated-fda-nod-foundayo">reports</a>.</p>
<p>While Novo was first to market with both injectable Wegovy and its Wegovy pill, the company has subsequently ceded its superior obesity market share in the U.S. to Lilly. </p>
<p>Eligible patients can choose three-, six-or 12-month subscriptions, and longer treatment periods will also be eligible for lower monthly prices. Users can save up to $1,200 on injection pens with the following subscriptions: </p>
<ul><li>3-month subscription: $329 per month, savings of $240 per year</li><li>6-month subscription: $299 per month, savings of $600 per year</li><li>12‑month subscription: $249 per month, savings of $1,200 per year</li></ul>
<p>The 7.2-mg dose will be added to the program later, the announcement said. </p>
<p>The pill form of the drug, <a href="https://www.fiercepharma.com/pharma/novos-wegovy-pill-makes-us-debut-starter-dose-launching-149-month-cash-paying-patients">launched</a> in the U.S. in January, is also available under the subscription plan. Here’s a breakdown of savings, up to $600 annually, for 9-mg and 25-mg doses with each subscription:</p>
<ul><li>3-month subscription: $289/month, savings of $120 per year</li><li>6-month subscription: $269/month, savings of $360 per year</li><li>12‑month subscription: $249/month, savings of $600 per year</li></ul>
<p>For the pill, eligible patients will pay $149 per month for each of the 1.5-mg and 4-mg doses. The price for the 4-mg dose will increase to $199 per month beginning Aug. 31.</p>
<p>Patients will be able to enroll in the subscription plan through <a href="https://www.fiercehealthcare.com/health-tech/hims-hers-lifemd-stock-skyrockets-after-inking-deal-novo-nordisk-sell-wegovy">Ro</a>, <a href="https://www.fiercehealthcare.com/health-tech/novo-nordisk-inks-partnership-weightwatchers-broaden-wegovy-access">WeightWatchers</a>, <a href="https://www.fiercehealthcare.com/health-tech/hims-hers-lifemd-stock-skyrockets-after-inking-deal-novo-nordisk-sell-wegovy">LifeMD, Him & Hers</a> and Sesame. More telehealth providers will be announced at a later date, and patients are urged to directly contact providers for complete program terms. </p>
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<td><a href="https://www.fiercehealthcare.com/payers/blue-shield-californias-virtual-blue-plan-continues-show-lower-costs-increased-access" style="font-family:Helvetica, sans-serif; letter-spacing:-1px;margin:0;padding:0 0 2px;font-weight: bold;font-size: 19px;line-height: 20px;color:#222;">A look at 3 years of Blue Shield of California’s Virtual Blue</a>
<div style="font-family:Helvetica, sans-serif; text-align:left;color:#999;font-size:11px;font-weight:bold;line-height:15px;">Apr 3rd 2026, 13:45</div>
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<p><div class="col content" morss_own_score="5.425531914893617" morss_score="39.42986091922262">
<p>Blue Shield of California’s Virtual Blue plan continues to see positive results for enrolled members, including an overall 7% to 10% overall reduction in cost of care, the insurer <a href="https://news.blueshieldca.com/2026/04/02/virtual-care-is-here-to-stay-blue-shield-of-californias-virtual-blue-program-delivers-improved-access-more-affordable-health-care-high-patient-satisfaction">announced</a> Thursday.</p>
<p>The virtual-first program, which was <a href="https://www.fiercehealthcare.com/payers/blue-shield-california-teams-accolade-new-virtual-first-plan">first launched in 2023</a> in collaboration with Accolade and TeleMed2U, has more than 150,000 members to date. It allows members to access a slew of virtual health services at no additional cost as well as receive care from providers in Blue Shield's PPO network.</p>
<p>Blue Shield of California Senior Vice President of Commercial Markets Tim Lieb said in a statement the platform has been a "win for members, employers and our Blue Shield mission.” </p>
<p>“Members can get appointments faster and save on out-of-pocket costs; employers can offer more equitable access regardless of demographics; and as a nonprofit health plan, we’re advancing our commitment to high‑quality, affordable care for all Californians,” Lieb said.</p>
<p>The insurer said average wait times for the program “significantly outperform” statewide in-person averages across California, citing data from the California Department of Managed Care. Members seeking primary care saw a one day wait versus patients waiting 10 days for in-person care. Specialty care also saw decreased wait time—three days for Virtual Blue versus 15 days for in-person care.</p>
<p>Moreover, emergency room visits have dropped by more than 10% among Virtual Blue members—with 60% of members saying they would have turned to costlier care, like the emergency room, without the plan. </p>
<p>Virtual Blue has also expanded access to healthcare in rural areas, the insurer notes. </p>
<p>As the program continues to show benefits for members, the insurer recently added virtual primary care options to its Trio HMO plan. It also plans to continue adding Virtual Blue as an option to “more group employer plans over the next several months.”</p>
<p>“Virtual‑first care expands access and bridges critical care gaps,” said Carol Koeble, M.D., regional medical director at Blue Shield of California, in a statement. “It supports busy families, shift workers, those with mobility challenges, and people living in areas with provider shortages or disaster risks—and everyone in between.”</p>
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<p><strong>Forwarded by:<br />
Michael Reeder LCPC<br />
Baltimore, MD</strong></p>
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