Essential to any high-performing health system is coordination of primary care with other medical care and social services that patients receive. When primary care practices, specialists, hospitals, and social service providers work in harmony, patient outcomes are optimized. Half of Americans have multiple chronic conditions, such as heart disease, cancer, stroke, and diabetes. For these patients, their…

Participation in mandatory value-based payment programs is tied to higher annual administrative costs for hospitals, according to a comparative study published in JAMA Health Forum. The analysis reviewed Medicare cost report data for different types of hospitals that did and did not participate in three mandatory programs initiated by the Centers for Medicare and Medicaid…

Beginning Jan. 1, 2027, the Centers for Medicare & Medicaid Services (CMS) will launch the Long-term Enhanced ACO Design (LEAD) Model, a 10-year accountable care organization (ACO) initiative that succeeds ACO REACH. Unlike earlier ACO models, LEAD is built to draw in a broader range of practices, including smaller, independent and rural physician groups that have…

The Centers for Medicare & Medicaid Services (CMS) recently established CJR-X, a national episode- based payment model for lower extremity joint replacement (LEJR) procedures in the FY 2027 Medicare Inpatient Prospective Payment System (IPPS) Final Rule. This bundled payment model assesses cost and quality for 90-day episode for inpatient and outpatient hip, knee, and ankle…

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…