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RECORDED WEBINAR: From Policy to Member Action: Preparing for Medicaid Community Engagement Requirements

 Download Slides New Medicaid community engagement requirements are approaching, and for health plans, preparation extends well beyond understanding the policy. Under CMS’s current framework, certain Medicaid adults will be required to meet community engagement requirements or qualify for an exemption, with states generally required to implement the new requirements by January 1, 2027. When…

From Fragmentation To Coordination: Rethinking Health Care Cost Management With Insurance Incentives

Reducing health care spending and improving population health needs a comprehensive approach to replace the current fragmented silo-based approaches. Thoughtful program designs with financial incentives and clear metrics have demonstrated that health care can be delivered at lower cost with similar or better outcomes than currently. Yet significant obstacles remain: Underinvestment in primary care and…

ACOs are ‘the best way to deliver health care,’ CMS chief Dr. Oz says

National Association of ACOs hosts leader at fall conference. Accountable care organizations (ACOs) are the best way to deliver health care, the nation’s Medicare chief said. Now federal health leaders and ACO participants must join to recruit practices that are not in an accountable care model. Centers for Medicare & Medicaid Services Administrator Mehmet Oz,…

8 things to know about 2027 Medicare Advantage star ratings

CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans, but they also shape quality bonus payments to boost benefits. Four stars is the main…

Why Medicare Accountable Care Organizations should care about the Medicare GLP-1 Bridge program

The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program. Overview of the Medicare GLP-1 Bridge demonstration program CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1…

RECORDED WEBINAR: CJR-X finalized: How are hospitals positioned for mandatory LEJR episodes of care?

 Download Slides In the Fiscal Year 2027 Inpatient Prospective Payment System Final Rule, CMS finalized a national, mandatory expansion of the Comprehensive Care for Joint Replacement (CJR) Model, to be called CJR Expanded (CJR-X). CJR-X will hold all eligible acute care hospitals accountable for 90-day episodes of care following lower extremity joint replacement procedures….

How to divide shared savings without dividing the practice

It’s shared savings season and the check has arrived. Now how do physicians divide it up fairly? The Medicare Shared Savings Program check arrives in the fall. It is larger than anyone expected, and within a week, the collegiality of your partnership is under more strain than it has seen in years. Everyone agrees the…

Paper cutout of a Medicaid umbrella sheltering a house and family

ACO’s Stove Replacement Program Called ‘Truly Value-Based Care in Action’

To reduce asthma emergencies, Medical Home Network ACO is replacing Medicaid patients’ gas stoves with electric stoves Medical Home Network (MHN) and the MHN ACO are launching an asthma prevention program that will replace gas stoves with electric stoves for MHN ACO Medicaid patients. Chicago-based MHN is focused on transforming care in the safety net through…

Medicare penalizes more hospitals for readmissions

About 80% of hospitals are having their Medicare payments shaved down because of the Hospital Readmissions Reduction Program this fiscal year, compared to 78% the year prior, according to CMS data. Dive Brief: The number of hospitals penalized under a Medicare program meant to prevent avoidable readmissions continues to tick up. Eighty percent of hospitals,…

Bringing Safety-Net Providers Into Value-Based Care

Three lessons from the Population Health Management Initiative can help accountable care organizations and health plans to build realistic approaches to value-based payment for a broader set of primary care practices. Enthusiasm continues for value-based care models that improve population health to be adopted outside of large, integrated delivery systems. The Centers for Medicare and…

RECORDED WEBINAR: Prevention of Diabetic Foot Ulcers: The Role of Telemedicine and Technology

 Download Slides Diabetic foot ulcers remain a leading driver of hospitalization, amputation, and cost in patients with diabetes—yet up to 75% are preventable with the right tools and strategies. This presentation will trace the evolution of DFU prevention from early temperature-guided avoidance therapy to today’s remote temperature monitoring and AI-enabled care, grounded in clinical…

Winning Fourth Quarter Strategies for ACOs

We are officially in Q4 now. There are less than 90 days to make your 2026 performance year a success and prepare for 2027. What can and should ACOs be doing right now? That is the topic of this week’s installment. Below you will find what is perhaps the most important strategy for various types…

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