Report · Medicare Advantage outlook · August 2026

The 2028 pledge makes functional GI a 2026 decision.

Health plans covering 165 million lives have pledged outcome-based payment structures by January 2028. This report works backward from that date for functional GI care.

165mlives covered by the payer pledge for outcome-based payment by 2028
1 in 3adults 65+ met Rome IV criteria for a disorder of gut-brain interaction
5.7xexpected gross ROI for a first MA cohort. Modeled, not observed results

Inside the report.

01
Why the January 2028 pledge creates a 2026 contracting decision.
02
The functional GI care gap for adults aged 65 and over.
03
What Nerva platform data says about engagement among members 65 and over.
04
How to structure pay for verified success on ACCESS-pattern rails.
05
An ROI model that plans can rerun with their own population and claims data.

Every number in the report carries one of three labels: public evidence, Nerva data, or proposed model. The payer pledge spans Medicare Advantage, Medicaid and private insurance and is not GI-specific. CMS did not commission, contribute to, or endorse the report.

See how Nerva applies it in Medicare Advantage.

For Medicare Advantage plans

Report · Medicare Advantage outlook · August 2026

The 2028 pledge makes functional GI a 2026 decision.

Health plans covering 165 million lives have pledged outcome-based payment structures by January 2028. This report works backward from that date for functional GI care.

165mlives covered by the payer pledge for outcome-based payment by 2028
1 in 3adults 65+ met Rome IV criteria for a disorder of gut-brain interaction
5.7xexpected gross ROI for a first MA cohort. Modeled, not observed results

Inside the report.

01
Why the January 2028 pledge creates a 2026 contracting decision.
02
The functional GI care gap for adults aged 65 and over.
03
What Nerva platform data says about engagement among members 65 and over.
04
How to structure pay for verified success on ACCESS-pattern rails.
05
An ROI model that plans can rerun with their own population and claims data.

See how Nerva applies it in Medicare Advantage.

For Medicare Advantage plans