Humana saw a 24.3% decrease in inpatient admissions, or a 229,000-stay dip, for Medicare Advantage members in value-based care arrangements versus those in traditional Medicare in 2024, according to Humana’s “12th Annual Value-based Care Report,” published Feb. 4. Humana reviewed 2024 data to evaluate outcomes for its Medicare Advantage members. Seventy-one percent of Humana individual MA members…
As the Centers for Medicare and Medicaid Services (CMS) hits reset on an important value-based care initiative popular with health care providers, including nursing homes, providers will need to make considerations this spring on whether to participate in the new model called LEAD – short for Long-term Enhanced ACO Design. Starting in 2027, the federal…
Medicare beneficiaries whose physicians participate in accountable care organizations (ACOs), particularly those taking on financial risk for cost and quality, receive substantially more primary and preventive care than beneficiaries outside of these models, according to new data released by Accountable for Health (A4H). The evidence reinforces the role of value-based care structures in driving early intervention, better…
On February 4, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet about the 2026 Medicare Accountable Care Organization (ACO) participation. As of January 2026, an estimated 14.3 million Medicare beneficiaries will receive care coordinated by ACOs, up from 13.7 million in 2025, marking a 4.4 percent increase, CMS reported. This includes patients whose…
Download Slides As healthcare organizations take on greater accountability for outcomes and cost, managing chronic disease requires more than retrospective reporting. This session examines how earlier risk identification, sustained patient engagement, and coordinated care delivery can work together to improve outcomes and reduce avoidable utilization—particularly in high-burden chronic conditions. Speakers: Reynaldo Villar, Digital Architect…
The healthcare industry is at a critical inflection point and the promise of value-based care is at risk due to operational complexity and clinician burnout. AI offers a potential lifeline to streamline processes and restore focus on patient care. However, widespread adoption is stalling. Concerns around trust, transparency, and usability are slowing progress. This isn’t just…
Today’s Medicare program faces familiar cost and quality challenges. Medicare Part A is projected to be insolvent in 2033 and will start drawing down funds from the Part A Trust Fund in 2028. While moderating slightly during the COVID pandemic, spending growth has increased and remains high – 8.1 percent in 2023. Medical complexity also remains a challenge, with…
Download Slides As of January 1, 2026, CMS’s Transforming Episode Accountability Model (TEAM) is live – and for selected hospitals, participation is mandatory. TEAM is more than a reimbursement change. It is a readiness test for value-based care, demanding tighter financial, clinical, and operational coordination. Unlike voluntary programs such as BPCI Advanced, TEAM requires…
Download Slides Last year we saw a shift in the CMS Value-Based Care Program, with the announcement of two specialty care risk payment models, and the retirement of several models like Primary Care First, Making Care Primary, and alterations in Kidney Care Choices. CMS also restated its strategies for Value-Based Care, requiring the inclusion…
As healthcare organizations deepen their investments in value-based care, one obstacle continues to stymie progress: incomplete visibility into the patient’s health status. The problem isn’t limited to a single source, such as claims data, though claims are often blamed. Rather, it’s the fragmented nature of healthcare data itself. Patient information is dispersed across a patchwork of…
Accountable care organizations (ACOs) aim to improve patient care by managing their conditions and maintaining access to affordable care. To do so, ACOs amass data about patient health and spending, and there’s a potentially positive side effect: ACOs can serve as watchdogs to guard against wasteful and fraudulent spending in health care. That has happened over…
With TEAM’s focus on improving surgical recoveries and costs in major hospital-based surgeries, it’s easy to miss the importance of primary care physicians. But their role is essential for meeting TEAM’s objective to improve patient recovery and lower costs in the five major types of surgery covered by TEAM. And perhaps not in the way…