AI risk alerts, new biomarkers and expanded screening are landing on primary care physicians without added time or staff. Shifting outreach, testing coordination and closed-loop referrals to partners can help practices close the gap. Medicine has learned to identify risk and diagnose diseases faster than health care has learned to manage them. Before walking into…

Why artificial intelligence in health care falls short today and how implementing technology in health care requires integrated workflows to cut costs and improve outcomes. Health care has spent decades searching for transformation through technology. Electronic health records digitized the medical chart. Analytics gave organizations greater visibility into performance. Cloud infrastructure and interoperability expanded access…

A practical guide for physicians participating in ACOs, CINs and value-based contracts. Shared-savings statements arrive looking authoritative: clean tables, precise dollar figures and risk scores carried to three decimal places. But precision is not accuracy. Every shared-savings number is the product of a chain of assumptions about attribution, risk, benchmark construction, trend, quality and distribution….

Despite gradual adoption of value-based payment models, fee-for-service remains dominant. Utilization patterns from value-based models can be used to identify misvalued services, which could inform payment adjustments in the physician fee schedule. Few tasks in health care policy are as daunting—or as important—as getting the prices right for medical services. In fee-for-service (FFS) payment, mispriced…

In the past year, the Innovation Center has built the foundation of its evidence-based prevention pillar. The Center intends to maintain momentum with new prevention-focused payment models to advance transformative practice change. More than 150 million Americans live with at least one chronic disease, driving the vast majority of health care spending in the US…

Health systems face a 2.31% conversion factor cut for most clinicians, while ACOs get a higher BASIC track sharing rate and the option to waive patient cost sharing. The Centers for Medicare & Medicaid Services (CMS) finalized a 2.31% cut to the Medicare physician fee schedule conversion factor for most clinicians in 2027, a deeper…

Congress and federal agencies have been examining the prospect of adjusting – or overhauling – hospice reimbursement systems. This is based on introduced pieces of legislation and a series of government reports from agencies like the Government Accountability Office (GAO), the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health…

Dive Insight: CVS is the latest in a growing list of insurers turning to the courts in a bid to hike their 2027 MA star ratings, after the quality scores slipped for many operators, threatening the lucrative bonus payments and other competitive advantages the ratings represent. To date, at least four other insurers — Alignment Healthcare, Healthfirst,…