Download Slides Dementia is the one cohort inside your total population that quietly damages all three economic levers: RAF recapture, avoidable medical cost, and triple-weighted Part D performance. This session lays out a caregiver-activated playbook to defend RAF under V28, reduce avoidable utilization, and turn dementia from a liability into a Stars asset. Visit…
Congress should replace today’s program-by-program approach to value-based purchasing with a unified platform of expected medical and patient-reported outcomes, defined uniformly, risk adjusted or stratified uniformly, and used across all payers. For a quarter of a century, the US has graded health care primarily on process and documentation — whether a box was checked, a…
One of the biggest disconnects in Medicare value-based care is that the architecture of value-based programs run by the Centers for Medicare and Medicaid Services (CMS) has not caught up with how health systems actually bill. More specifically, there’s a mismatch between the organizational unit CMS uses to administer accountable care and the way modern…
Download Slides With Comprehensive Care for Joint Replacement Expanded (CJR-X) set to launch January 2028, every eligible acute care hospital in the country is facing a new reality: mandatory bundled payments across a full 90-day episode window for joint replacement procedures. This is part of a broader and accelerating shift — CMS already made…
AI will “turbocharge” medical billing and drive up costs in the short term, CMS Administrator Dr. Mehmet Oz warned Wednesday. But he said the pain is worth it for long-term savings. CMS Administrator Dr. Mehmet Oz delivered a candid assessment of artificial intelligence’s impact on healthcare costs Wednesday: It’s going to get worse before it…
Amid growing public debate over how best to analyze spending on MA versus traditional Medicare, Dr. Amol Navathe stepped into the lion’s den to defend MedPAC’s work. The leader of an influential congressional advisory group is defending its estimates of Medicare Advantage overpayments amid growing controversy over how to best analyze spending in the privatized Medicare…
Download Slides Quality reporting is a requirement for participants in ACOs, MIPS and other Alternate Payment Models. However, despite its value, quality reporting is often seen as a compliance exercise, rather than an opportunity to measure and improve quality. This short-term approach costs organizations (literally) when actionable insights go unrecognized, resulting in high-cost utilization…
New tracks broaden the reach of a model in which outcome-aligned payments, referral strategy and provider co-management are key areas of consideration. CMS continues to put weight behind the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a 10-year initiative to apply value-based payment and digital solutions to chronic disease management. The agency announced…
Download Slides Clinical accuracy is the foundation of value-based care, but recent, high-profile enforcement actions have shown how much is at stake when the focus turns from delivering great care to optimizing coding. How can physician groups, ACOs and health systems capture true patient acuity without crossing into upcoding? Join Connective Health for a…
Stephanie Carlton, CMS’ deputy administrator and chief clinical AI officer, said CMS will soon roll out an ‘Investing in Health Outcomes Pledge’ Over the past few years there have been efforts to streamline Medicaid quality measures and start to move to measures that matter in terms of outcomes. During a recent Manatt webinar, Stephanie Carlton,…
For most of the last century, Type 1 Diabetes announced itself with an acute crisis. A child gets sick, sometimes critically sick, and the diagnosis arrives in the emergency department. The standard clinical response is therefore reactive: wait for symptoms to appear, manage the acute crisis – often Diabetic Ketoacidosis (DKA) – and then initiate…
Physician groups back ACCESS Model but warn CMS against care fragmentation Medicare’s new ACCESS payment model will succeed only if it strengthens the relationships between patients and their primary care physicians. But the new payment model includes the risk of fragmenting patient care instead of bolstering the comprehensive treatment plans guided by primary care doctors….