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…

Healthcare continues to feel pressure: financially, operationally, politically, and culturally. Patients are more frustrated than ever with the cost of care and confusing billing practices. Clinicians are stretched to their limits with ever-increasing responsibilities. Payers are on the defense to justify their decisions. Trust has frayed between all parties. One particularly dark spot is the…

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…