On July 5th, CMS launched the ACCESS Model, a 10-year voluntary Medicare payment test paying for outcomes across four chronic care tracks. Alongside it, CMS shipped a full replication kit for the private payer market, and 14 of the largest health plans in the country signed the ACCESS Aligned Payer Pledge, covering 165 million member lives across Medicare Advantage, Medicaid, and commercial coverage, committing to offer ACCESS-Aligned arrangements by January 1, 2028. The surprise: the questions health plans will start asking vendors about outcome thresholds, defined care periods, and coordination with other providers start showing up in RFP language as early as this fall, whether or not the plan running the evaluation signed the pledge.

In this episode of the Upward Growth Podcast, Ryan Peterson walks through what ACCESS-Aligned means for health tech vendors selling into health plans, and what the evaluation question set will look like over the next 24 months. The episode goes one level deeper on why ACCESS-Aligned language lands in Q4 RFPs, unpacks the PE-side diligence patterns Ryan has been hearing over the last two weeks, and lays out what to do between now and the end of Q3 if your outcome story is not ready.

What you'll hear:

• What ACCESS-Aligned means, why the four principles are the anchor, and how the replication kit (sample provider agreement, standardized G-codes, CMS-hosted FHIR API) compresses private payer adoption timelines
• Why plans that never signed the pledge, and may not have Traditional Medicare business at all, end up asking the same questions in their vendor evaluations
• Which health tech categories just got elevated (cardio-kidney-metabolic, MSK, behavioral outcome measurement, care coordination, outcome measurement infrastructure), and which got deprioritized
• How ACCESS-Aligned reaches your buyer across Medicare Advantage (via the MA signatories), Medicaid (via Centene), and self-insured employer (via CVS Health)
• The 18-month timeline of milestones to watch, starting with when CMS publishes the sample provider agreement
• The specific instructions for vendors between now and the end of Q3, and why the repositioning window closes mid-2027

Read the full analysis in the Upward Growth newsletter: What the ACCESS Model Signals About Where CMS Wants Outcome-Based Chronic Care to Go

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

Subscribe to the newsletter: https://upwardgrowth.substack.com/

Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com

MedPAC's June 2026 report to Congress dropped on June 15 and attached $22 billion in higher-than-justified Medicare Advantage payments in 2026 to coding intensity alone. The same report documented $23.7 billion in improper MA payments for fiscal year 2025 and endorsed a federal role for technology in fixing Medicare enrollment, in the same chapter that flagged the broker channel as part of the problem the technology is meant to solve.

In this episode of the Upward Growth Podcast, Ryan Peterson walks through how the three MedPAC findings change the procurement conversation inside MA plans for the rest of 2026. The episode goes past the article to spend time on why the risk adjustment buyer profile has shifted on both sides of the CMS intensity adjustment, what the WISeR Model means for the AI utilization management category, and three live questions over the next 90 days that will shape what plans buy in 2027. Vendors hear which version of the buyer they're actually selling to. Investors hear which sub-segments of the MA market and which vendor categories are getting repriced. Health plans hear how the report sorts their peers and what their procurement counterparts are now being asked to defend.

What you'll hear:

• Why MedPAC's three findings, read as one document, change who the buyer is inside the plan for risk adjustment, utilization management, and member experience
• How the half of MA plans coding above the CMS intensity adjustment and the half coding below it are operating differently in 2026
• Why compliance, legal, and the CFO are now at the risk adjustment vendor table on both sides of that line
• What the WISeR Model means for the AI utilization management category, now that CMS itself is the buyer under a shared-savings contract
• How the June 17 CMS guidance memo on the 2027 Quality Bonus Payment ratings reshapes the ROI conversation around member experience investments
• Three things to watch over the next 90 days: the CMS appeal on Clover, the eviCore strategic review outcome, and the RADV extrapolation methodology

Read the full analysis in the Upward Growth newsletter: Three Things MedPAC Just Told Congress That Will Change What Health Plans Buy

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

Subscribe to the newsletter: https://upwardgrowth.substack.com/

Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com

On April 2, CMS published the CY 2027 Final Rule and tripled the weight of two Health Outcomes Survey measures inside the Medicare Advantage Star Ratings. By 2029, HOS and CAHPS will drive close to 40 percent of the total Star Ratings calculation. The shift pulls every health tech vendor that touches a Medicare Advantage member into the Star Ratings conversation, whether or not they have ever positioned their product as Stars-relevant.

In this episode of the Upward Growth Podcast, Ryan Peterson introduces the concept of member memory, a vendor-facing lens for understanding what HOS is actually capturing about the touchpoints a vendor delivers on behalf of a health plan. The episode walks through which categories of vendors are most exposed under the new weighting, a four-stage progression that every vendor should run against each of their health plan customer relationships before their next renewal, and the two questions every health plan will ask in the next renewal cycle.

What you'll hear:

• What member memory is and how it gives a vendor a clearer view of their own role in Medicare Advantage Star Ratings outcomes
• Why HOS and CAHPS will drive close to 40 percent of the total Star Ratings calculation by 2029
• The vendor categories most exposed under the new weighting: risk adjustment, care management, member apps, prior auth automation, behavioral health, and call centers
• The four kinds of member memory and which categories of vendor sit inside each
• A four-stage progression for evaluating where a vendor relationship actually stands with a health plan customer (walked through with a meal delivery example)
• How the CFO filter at health plans is compounding the new HOS weighting and what that means for contracts already on the books
• The two questions every health plan is going to ask in the next renewal cycle and how to know if you can credibly answer them

Read the full analysis in the Upward Growth newsletter: The 2027 Star Ratings Tripled the Weight of Member Experience. Here's What That Changes About Selling to Health Plans.

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

Subscribe to the newsletter: https://upwardgrowth.substack.com/

Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com

On May 27, a federal judge in Georgia threw out 20 Medicare Advantage Star Ratings measures from Clover Health's 2026 rating and ordered CMS to recalculate. The order is narrow. The reasoning is not.

In this first episode of the Upward Growth Podcast, Ryan Peterson breaks down why Clover v. HHS is structurally different from every prior Star Ratings lawsuit, why your buyer at the plan got harder to close overnight, and where you actually sit in the fallout depending on where you operate in the market.

What you'll hear:

- The single-sentence way to explain why this case is different from prior Star Ratings litigation

- What changed about who weighs in on Stars decisions at health plans

- A three-zone exposure framework for figuring out where you sit in the fallout

- The Loper Bright throughline and what it signals about the broader regulatory environment

- Predictions on appellate timeline and likely outcome

Read the full analysis in the Upward Growth newsletter: Clover v. HHS Is Not Just Another Star Ratings Lawsuit

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

Subscribe to the newsletter: https://upwardgrowth.substack.com/

Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com

The Upward Growth Podcast is the new audio channel from Upward Growth, a health plan market advisory firm. Host Ryan Peterson breaks down what's actually moving in the health plan market and what it means for the people selling into it, investing in it, or building for it.

Think of it as the audio version of the weekly Upward Growth newsletter, plus occasional conversations with the operators, investors, and builders working on what we cover. Each episode unpacks how plans are making buying decisions right now, what earnings calls and CMS rules actually mean for vendors, and the structural shifts changing who's buying what and why.

If you're making bets on the health plan market, this show is built for you.

Hit subscribe wherever you get your podcasts.

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

Subscribe to the newsletter: https://upwardgrowth.substack.com/

Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com