Value-based care continues to account for a substantial share of U.S. healthcare payments, underscoring sustained payer investment in payment models that link reimbursement to quality and cost outcomes. The findings come from a survey released by AHIP in collaboration with the Centers for Medicare and Medicaid Services. Danielle Lloyd, M.P.H., AHIP’s senior vice president of private market…
The CMS TEAM payment model focuses on the patient surgery and recovery process, which puts hospitals at risk for both cost and quality of surgeries. The end result of TEAM, if implemented well by hospitals and clinicians, is benefits for patients, with more coordination of services and fewer complications. The American College of Surgeons supports…
CMS released participation data Feb. 4 for Medicare accountable care organizations in 2026, showing continued growth in enrollment and a record number of beneficiaries served by the Shared Savings Program. Six things to know: An estimated 14.3 million Medicare beneficiaries are receiving care coordinated by ACOs as of January 2026, up from 13.7 million in 2025, a…
The Centers for Medicare & Medicaid Services (CMS) is moving steadily toward the use of FHIR-based digital quality measures (dQMs). CMS believes dQMs will enable a more dynamic, interoperable, and comprehensive approach to quality measurement than the electronic clinical quality measures (eCQMs) currently in use. As it seeks public feedback on draft dQM packages, CMS officials held…
What You Should Know The Report: Humana’s newly released Value-Based Care By the Numbers Report, reveals that Medicare Advantage members in value-based care (VBC) arrangements are seeing significantly better outcomes than those in traditional models. The Data: The impact is measurable and massive: VBC patients experienced 24.3% fewer hospital admissions and 13.4% fewer emergency room visits in 2024. The Shift: The report…
On January 1, 2026, approximately 700 hospitals across the United States began mandatory participation in the Centers for Medicare & Medicaid Services’ (CMS’) Transforming Episode Accountability Model (TEAM). TEAM is CMS’ new bundled payment model where participants will be taking on financial risk for the costs and quality outcomes of Medicare fee-for-service (FFS) beneficiaries undergoing…
Humana saw a 24.3% decrease in inpatient admissions, or a 229,000-stay dip, for Medicare Advantage members in value-based care arrangements versus those in traditional Medicare in 2024, according to Humana’s “12th Annual Value-based Care Report,” published Feb. 4. Humana reviewed 2024 data to evaluate outcomes for its Medicare Advantage members. Seventy-one percent of Humana individual MA members…
As the Centers for Medicare and Medicaid Services (CMS) hits reset on an important value-based care initiative popular with health care providers, including nursing homes, providers will need to make considerations this spring on whether to participate in the new model called LEAD – short for Long-term Enhanced ACO Design. Starting in 2027, the federal…
Medicare beneficiaries whose physicians participate in accountable care organizations (ACOs), particularly those taking on financial risk for cost and quality, receive substantially more primary and preventive care than beneficiaries outside of these models, according to new data released by Accountable for Health (A4H). The evidence reinforces the role of value-based care structures in driving early intervention, better…
On February 4, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet about the 2026 Medicare Accountable Care Organization (ACO) participation. As of January 2026, an estimated 14.3 million Medicare beneficiaries will receive care coordinated by ACOs, up from 13.7 million in 2025, marking a 4.4 percent increase, CMS reported. This includes patients whose…
Download Slides As healthcare organizations take on greater accountability for outcomes and cost, managing chronic disease requires more than retrospective reporting. This session examines how earlier risk identification, sustained patient engagement, and coordinated care delivery can work together to improve outcomes and reduce avoidable utilization—particularly in high-burden chronic conditions. Speakers: Reynaldo Villar, Digital Architect…
The healthcare industry is at a critical inflection point and the promise of value-based care is at risk due to operational complexity and clinician burnout. AI offers a potential lifeline to streamline processes and restore focus on patient care. However, widespread adoption is stalling. Concerns around trust, transparency, and usability are slowing progress. This isn’t just…