Addressing Structural Challenges in the Business of Benefits Through AI Innovation Employer plans, whether self-funded under the Employee Retirement Income Security Act of 1974 (ERISA) or fully funded through a commercial plan, will likely have a proactive mindset that will lead to greater coverage modeling scenarios, plan accountability, and a focus on outcomes to successfully…
AI isn’t failing because it lacks capability. It’s failing because it isn’t consistently reaching the moments where decisions are made. Healthcare isn’t struggling to adopt AI. In fact, the industry has moved quickly from early experimentation to widespread investment in tools designed to improve clinical decision-making, reduce administrative burden, and drive financial performance. Many health…
Value-based care runs on a simple bet: an organization takes financial responsibility for a population’s health and keeps the savings if it can hold costs down. The organizations making that bet, physician-led IPAs, ACOs, Medicare Advantage groups, and the health plans they contract with, all run the same kind of back office to deliver on…
Healthcare’s data isn’t missing. It’s everywhere. We talk about value-based care like it’s a contracting problem. Get the attribution and quality measures right, and performance follows. But the real work of winning under risk happens inside a 15-minute visit, with a physician rebuilding a patient’s story from records scattered across the EHR, an HIE, a…
When physicians describe the forces reshaping medicine, they increasingly point not to a new device or a breakthrough drug but to the economics underneath their work. The move from fee-for-service to value-based payment is no longer theoretical. For a growing number of specialists, it is starting to feel personal. That change in perception is worth…
During 2025, the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS) announced seven new value-based payment models. Among these new models is the Ambulatory Specialty Model (ASM), which is specifically focused on improving efficiency in care for two chronic conditions—lower back pain and heart failure. Another new model, the Long-term Enhanced…
Despite its increasing use, artificial intelligence integration is lagging at healthcare systems and organizations across the U.S., according to a new survey from Arcadia. Fifty-two percent of respondents report that AI can fundamentally transform healthcare in correct applications, though about half (53%) of AI insights are “only partially embedded” into decision-making processes and only 14% report full…
Download Slides How Predictive Prevention Can Help CAHs Extend Care, Reduce Burnout, and Improve Value-Based Performance Rural hospitals face growing pressure from staffing shortages, chronic disease, and rising value-based care demands. This webinar explores how predictive prevention, automation, and continuous patient engagement can help Critical Access Hospitals extend care beyond their walls, reduce avoidable…
Download Slides In this 2026 measurement year, CMS’s sociodemographic status (SDS) risk adjustment is changing how medication adherence is measured, who you need to focus on, and why it matters more than ever. One in eight Medicare beneficiaries qualifies through disability rather than age, and this population underperforms across all three adherence measures by…
Nephrology occupies a uniquely strategic position in value-based care. Few specialties sit so directly at the intersection of clinical complexity, rising utilization, and outsized healthcare spend. Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are among the most resource-intensive conditions in Medicare, making kidney care one of the clearest opportunities for specialty-driven value creation….
When I think about what defines high-quality health care, I don’t start with a single visit or a specific service. I start with a broad view of the full care experience: how care is delivered over time, across settings and among care teams. High-quality care is built through coordination, prevention and a deep understanding of…
Medicare’s unprecedented and unpredictable spending growth in recent years is penalizing clinicians who have been most effective at slowing cost growth and improving care. The Accountable Care Prospective Trend (ACPT) in the Medicare Shared Savings Program (MSSP) could cost accountable care clinicians more than $700 million in lost shared savings for care delivered in 2025….