Seema Verma. Photo: Bill Clark/CQ Roll Call

The Trump administration has a message for accountable care organizations, a cost-cutting enterprise encouraged by the Affordable Care Act: You're either in or you're out.

The big picture: ACOs are one of the many efforts to get doctors, hospitals and other providers to work together — and get paid together — under the belief that greater collaboration will both save money and improve quality.

  • To that end, there were two initial models to entice providers into joining ACOs. One allowed them to share in whatever savings they accrued for Medicare.
  • The other track gave ACOs a bigger share of those savings, but only on the condition that they also accept financial penalties if they missed their savings targets.

The no-risk track is shrinking, the Centers for Medicare and Medicaid Services said yesterday. From now on, if you want to be in an ACO, you can only stay in the reward-only model for two years before accepting some risk. That's down from six years now.

  • CMS acknowledged that this will lead to a decline in participation, but it believes the remaining ACOs will be the ones that drive the biggest savings.
  • “There are successes — and there are successes when providers are wiling to take on two-sided risk," CMS Administrator Seema Verma told reporters.

Go deeper: Read the new rules, or read Verma's summary of the new rules in Health Affairs.

Go deeper

Updated 3 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 7 p.m. ET: 12,859,834 — Total deaths: 567,123 — Total recoveries — 7,062,085Map.
  2. U.S.: Total confirmed cases as of 7 p.m. ET: 3,297,501— Total deaths: 135,155 — Total recoveries: 1,006,326 — Total tested: 40,282,176Map.
  3. States: Florida smashes single-day record for new coronavirus cases with over 15,000 — NYC reports zero coronavirus deaths for first time since pandemic hit.
  4. Public health: Ex-FDA chief projects "apex" of South's coronavirus curve in 2-3 weeks — Coronavirus testing czar: Lockdowns in hotspots "should be on the table"
  5. Education: Betsy DeVos says schools that don't reopen shouldn't get federal funds — Pelosi accuses Trump of "messing with the health of our children."

Scoop: How the White House is trying to trap leakers

Illustration: Sarah Grillo/Axios

President Trump's chief of staff, Mark Meadows, has told several White House staffers he's fed specific nuggets of information to suspected leakers to see if they pass them on to reporters — a trap that would confirm his suspicions. "Meadows told me he was doing that," said one former White House official. "I don't know if it ever worked."

Why it matters: This hunt for leakers has put some White House staffers on edge, with multiple officials telling Axios that Meadows has been unusually vocal about his tactics. So far, he's caught only one person, for a minor leak.

11 GOP congressional nominees support QAnon conspiracy

Lauren Boebert posing in her restaurant in Rifle, Colorado, on April 24. Photo: Emily Kask/AFP

At least 11 Republican congressional nominees have publicly supported or defended the QAnon conspiracy theory movement or some of its tenets — and more aligned with the movement may still find a way onto ballots this year.

Why it matters: Their progress shows how a fringe online forum built on unsubstantiated claims and flagged as a threat by the FBI is seeking a foothold in the U.S. political mainstream.