CMS value-based payment models underrepresent Black, Hispanic, dual-eligible, and disadvantaged Medicare beneficiaries compared with the broader population. Medicare beneficiaries who receive care through CMS’s largest voluntary value-based payment models are disproportionately White and less likely to be dual eligible for Medicare and Medicaid or live in disadvantaged or rural areas than those outside these models, according to a…

Over the last few years, the excitement over value-based care had decreased, if not vanished. Growth in MSSP was steady but unspectacular. ACO REACH was an interesting experiment with no clear path forward. Specialists stayed mostly outside the tent. In conference rooms, the former golden child “value-based care” was dismissed as a has-been. The CY2027 Physician…

Why value-based care requires AI that tells clinicians not just who is at risk, but which interventions are most likely to change outcomes. Population health teams have made meaningful progress in identifying risk. Predictive models can flag patients at higher risk of complications, deterioration, or avoidable utilization. That visibility matters, but what comes next? Care teams may…

This summer, cool off with a cold drink and the 1,592-page 2027 CMS Physician Fee Schedule Proposed Rule! CMS has teased the elimination of Traditional MIPS and full transition to MIPS Value Pathways (MVPs for several years), and we now have a proposed date. Starting in Performance Year 2029, MVPs will be the only option for MIPS…

In North Dakota, references to the Rough Riders — a famed cavalry in the 1898 Spanish-American War — abound. The name graces hotels, grocery stores, and golf tournaments and has become a shorthand symbol of rugged individualism, bravery, and the willingness to act. A mix of cowboys, ranchers, Native Americans, and athletes from Ivy League…

Accountable care organizations (ACOs) have become an effective tool for Medicare to generate savings and catch health care fraud, said two advocates who described their firsthand experience with the model. Aisha Pittman, M.P.H., senior vice president of government affairs at the National Association of Accountable Care Organizations (NAACOS), and Katie Boyer, M.P.P.A., director of policy and government…

Population health management (PHM) is a data-driven approach that ACOs use to improve outcomes and lower total cost of care for a defined population by identifying risk before it becomes utilization, coordinating care across settings, and addressing the clinical and social factors that drive spending. For accountable care organizations (ACOs), PHM is not a philosophy….

The country’s underinvestment in primary care means missed opportunities to catch chronic disease early and help patients change unhealthy habits before those become costly, said the leader of Medicare’s Innovation Center. “We underinvest in primary care at the current prevailing payment rates,” said Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI)….