CMS’ Advancing Chronic Care with Effective, Scalable Solutions model launched July 5, testing whether paying organizations for outcomes — rather than specific services — can expand access to technology-supported chronic care. Behavioral health is one of four clinical tracks, alongside musculoskeletal pain and two cardio-kidney-metabolic tracks split by disease stage, putting depression and anxiety management on equal footing with…

For the longest time, physician practices have operated on a fee-for-service model that pays for visits, tests and procedures. We’re finally seeing a shift toward more value-based care models that base compensation on the quality of care and a patient’s longevity of health, a shift that I believe is better for all parties involved. The U.S. Centers for…

Health care leaders have long viewed fraud, waste, and abuse as compliance issues. But as more provider organizations accept financial risk through accountable care and other value-based arrangements, fraud, waste, and abuse are no longer simply compliance concerns. They are increasingly financial performance risks that can directly affect benchmark attainment, shared savings results, and care…

Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term sustainability, and the responses point to a shared shift away from volume-driven models toward outcomes, accountability, and member-centered design. From shifting social health programs toward measurable, evidence-based interventions to redesigning the…

In our last four articles, we have focused on payment models and infrastructure to establish how ACOs can be central to Value-Based Care, even under specialty models. Now it’s time to shift our focus back to what the payment models set out to do: improve patient health and rationalize costs. We cannot lift up patient…

Addressing Structural Challenges in the Business of Benefits Through AI Innovation Employer plans, whether self-funded under the Employee Retirement Income Security Act of 1974 (ERISA) or fully funded through a commercial plan, will likely have a proactive mindset that will lead to greater coverage modeling scenarios, plan accountability, and a focus on outcomes to successfully…

AI isn’t failing because it lacks capability. It’s failing because it isn’t consistently reaching the moments where decisions are made. Healthcare isn’t struggling to adopt AI. In fact, the industry has moved quickly from early experimentation to widespread investment in tools designed to improve clinical decision-making, reduce administrative burden, and drive financial performance. Many health…

Value-based care runs on a simple bet: an organization takes financial responsibility for a population’s health and keeps the savings if it can hold costs down. The organizations making that bet, physician-led IPAs, ACOs, Medicare Advantage groups, and the health plans they contract with, all run the same kind of back office to deliver on…

Why fragmented patient data became a financial and regulatory liability, and how clinical AI closes the gap at the point of care Healthcare’s data isn’t missing. It’s everywhere. We talk about value-based care like it’s a contracting problem. Get the attribution and quality measures right, and performance follows. But the real work of winning under…

When physicians describe the forces reshaping medicine, they increasingly point not to a new device or a breakthrough drug but to the economics underneath their work. The move from fee-for-service to value-based payment is no longer theoretical. For a growing number of specialists, it is starting to feel personal. That change in perception is worth…