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…
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…
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….
Download Slides Our last two webinars focused on accountable automation and a real-world Palm Beach ACO use case. In this session, we’d like to take the discussion one level higher and focus on the broader operating model ACOs will need as AI becomes more integrated into value-based care. The session would explore how ACOs…
A new study details how Medicaid Accountable Care Organizations can improve maternal healthcare quality and equity in the US by aligning performance mandates with innovative care coordination and social needs support among patients before, during, and after pregnancy. As the largest insurance program for maternity care, Medicaid is uniquely positioned to shape maternal health in…
Sixty percent of health plans are screening for social determinants of health, but gaps in how they use that information for maternal health still persist. Healthcare consulting firm Sage Growth Partners surveyed 50 health plan leaders and 300 recently pregnant women, as well as their caregivers, for a Sept. 9 report. About three-quarters of the health plan…
Researchers at the University of Edinburgh searched three databases on March 20 for work on how ambient artificial intelligence (AI) scribes are being implemented. They screened 1,333 results and were left with 27 articles. Thirteen were empirical studies. The narrative review, published Sept. 3 in BMJ Digital Health & AI, mapped those articles against the Non-Adoption,…
Download Slides As CMS moves toward outcome-based payment for chronic care at national scale, the next two model years give ACOs a period to build their own outcomes and utilization data before those expenditures affect benchmark calculations. CMS’s ACCESS Model went live in July 2026, bringing outcome-aligned payment for technology-supported chronic care into…