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RECORDED WEBINAR: From Raw Data to Quality Care: using Interoperability and clinical data infrastructure to close care gaps

 Download Slides Healthcare data is notoriously siloed across Electronic Health Records (EHRs), claims databases, and pharmacies. Capturing a complete longitudinal patient record is highly challenging, yet entirely achievable. The main obstacle is that raw data is rarely enough; medical records vary widely due to inconsistent workflows, and even common procedures like a colonoscopy surface…

RECORDED WEBINAR: What’s Next for RPM and CCM: Navigating CMS’s New Rules and Programs

 Download Slides CMS is rewriting the ground RPM and CCM programs stand on, from new billing rules to an entirely new payment model in the ACCESS program. Organizations running these programs today are planning around rules that are still moving. Dr. Beau Muñoz, Director of Medical Affairs at Pearl Health, joins Mark Aspenson, CEO…

Inside Tufts Medicine’s physician-led approach to data and AI

In a clinically integrated network where nearly 70% of primary care physicians are independent, leaders cannot rely on a traditional management structure to drive change. Physician governance and trusted data become essential to engagement and to whether AI-powered insights earn clinicians’ confidence. In a featured session sponsored by Arcadia and Navvis at Becker’s 11th Annual…

RECORDED WEBINAR: From Policy to Member Action: Preparing for Medicaid Community Engagement Requirements

 Download Slides New Medicaid community engagement requirements are approaching, and for health plans, preparation extends well beyond understanding the policy. Under CMS’s current framework, certain Medicaid adults will be required to meet community engagement requirements or qualify for an exemption, with states generally required to implement the new requirements by January 1, 2027. When…

Advancing Social Risk Adjustment In Value-Based Payment

To appropriately hold participants accountable for population outcomes, value-based payment models must account for the factors that drive variation in outcomes outside of participant performance. over time, there has been growing recognition that beyond clinical factors, social and economic conditions can play a role in shaping variation of population outcomes that are targeted by value-based…

Contributor: Medicare’s ACO Model Begins, Kidney Care Cannot Be Left Behind

As CKCC nears its sunset, kidney care leaders urge CMS to preserve a dedicated, nephrologist-led accountable care model for advanced kidney disease. In 2027, Medicare will enter an important transition in its continued evolution toward accountable care. The Long-term Enhanced Accountable Care Organization Design (LEAD) Model will begin a 10-year test intended to make accountable…

From Fragmentation To Coordination: Rethinking Health Care Cost Management With Insurance Incentives

Reducing health care spending and improving population health needs a comprehensive approach to replace the current fragmented silo-based approaches. Thoughtful program designs with financial incentives and clear metrics have demonstrated that health care can be delivered at lower cost with similar or better outcomes than currently. Yet significant obstacles remain: Underinvestment in primary care and…

ACOs are ‘the best way to deliver health care,’ CMS chief Dr. Oz says

National Association of ACOs hosts leader at fall conference. Accountable care organizations (ACOs) are the best way to deliver health care, the nation’s Medicare chief said. Now federal health leaders and ACO participants must join to recruit practices that are not in an accountable care model. Centers for Medicare & Medicaid Services Administrator Mehmet Oz,…

8 things to know about 2027 Medicare Advantage star ratings

CMS released 2027 Medicare Advantage star ratings on Oct. 8, giving more insight into the MA landscape beyond health plans’ marketing materials. Contracts receive a rating each year, ranging from one to five stars. The ratings help beneficiaries compare plans, but they also shape quality bonus payments to boost benefits. Four stars is the main…

Why Medicare Accountable Care Organizations should care about the Medicare GLP-1 Bridge program

The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program. Overview of the Medicare GLP-1 Bridge demonstration program CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1…

RECORDED WEBINAR: CJR-X finalized: How are hospitals positioned for mandatory LEJR episodes of care?

 Download Slides In the Fiscal Year 2027 Inpatient Prospective Payment System Final Rule, CMS finalized a national, mandatory expansion of the Comprehensive Care for Joint Replacement (CJR) Model, to be called CJR Expanded (CJR-X). CJR-X will hold all eligible acute care hospitals accountable for 90-day episodes of care following lower extremity joint replacement procedures….

How to divide shared savings without dividing the practice

It’s shared savings season and the check has arrived. Now how do physicians divide it up fairly? The Medicare Shared Savings Program check arrives in the fall. It is larger than anyone expected, and within a week, the collegiality of your partnership is under more strain than it has seen in years. Everyone agrees the…

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