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)….
The Trump administration is proposing sweeping changes to Medicare payment and value-based care programs that it says will expand accountable care, modernize physician payment, and help shift the healthcare system toward prevention rather than treatment. On Tuesday, the Centers for Medicare and Medicaid Services issued Medicare Part B payment policy changes for physicians under the…
The last two years have dramatically strengthened the ACO role in providing accountable care. New CMS specialty payment models—TEAM, ASM, and the proposed CJR-X—each include specific provisions for ACO coordination and referrals, extending the ACO’s reach deep into the specialty care continuum. LEAD, the new long-term ACO model with prospective payments, has redefined the future of…
A consistent theme is emerging in my conversations with Medicare Advantage and accountable care executives. Many organizations have worked the familiar levers — coding accuracy, pharmacy, post-acute utilization, network performance — and are now looking for the next meaningful source of clinical and financial improvement. One answer is already inside their attributed population; people living…
The Centers for Medicare and Medicaid Services (CMS) Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a voluntary CMS Innovation Center initiative designed to improve outcomes for Medicare fee for service (FFS) beneficiaries with chronic conditions through technology-enabled care. CMS announced the initial cohort of over 150 ACCESS participants in April 2026. These participants reflect…
Despite ongoing improvement, stakeholders highlight need to modernize how accountable care models are evaluated The 115 accountable care organizations that participated in ACO REACH in Performance Year 2024 generated $2.5 billion in gross savings, with $988.3 million returned directly to the Centers for Medicare and Medicaid Services (CMS), for the care of 2.5 million seniors,…
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…
When CMMI released the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, it did something the Innovation Center rarely does this narrowly. It built a payment experiment around specific measured outcomes. CMMI usually builds population-based payment incentives and bundled payments, with specific components around highly prevalent chronic conditions layered in rather than made the…
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…