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…
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….
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…
To reduce asthma emergencies, Medical Home Network ACO is replacing Medicaid patients’ gas stoves with electric stoves Medical Home Network (MHN) and the MHN ACO are launching an asthma prevention program that will replace gas stoves with electric stoves for MHN ACO Medicaid patients. Chicago-based MHN is focused on transforming care in the safety net through…
Three lessons from the Population Health Management Initiative can help accountable care organizations and health plans to build realistic approaches to value-based payment for a broader set of primary care practices. Enthusiasm continues for value-based care models that improve population health to be adopted outside of large, integrated delivery systems. The Centers for Medicare and…
Download Slides Diabetic foot ulcers remain a leading driver of hospitalization, amputation, and cost in patients with diabetes—yet up to 75% are preventable with the right tools and strategies. This presentation will trace the evolution of DFU prevention from early temperature-guided avoidance therapy to today’s remote temperature monitoring and AI-enabled care, grounded in clinical…
We are officially in Q4 now. There are less than 90 days to make your 2026 performance year a success and prepare for 2027. What can and should ACOs be doing right now? That is the topic of this week’s installment. Below you will find what is perhaps the most important strategy for various types…
Medicare’s Transforming Episode Accountability Model is projected to save $46.6 million by 2030, with safety-net hospitals potentially receiving the highest reconciliation payments. The Transforming Episode Accountability Model (TEAM), which was launched in January 2026 by CMS, is a mandatory episode-based payment model for hospitals. The model builds upon previous initiatives, such as the Bundled Payments…
Download Slides In value-based care, success relies on more than high-level strategy and individuals committed to VBC activities. It requires the ability to turn fragmented signals stemming from information, such as a patient’s medical, behavioral and social risk, care utilization and transitions, quality, and network performance into focused and aligned operational actions that can…
Download Slides Dementia is the one cohort inside your total population that quietly damages all three economic levers: RAF recapture, avoidable medical cost, and triple-weighted Part D performance. This session lays out a caregiver-activated playbook to defend RAF under V28, reduce avoidable utilization, and turn dementia from a liability into a Stars asset. Visit…
Behavioral health has historically taken a back seat to physical health in primary care. That approach is shifting, as growing evidence underscores the importance of whole-person well-being in improving patient outcomes, strengthening care coordination and advancing value-based care. For decades, and in some settings still today, people facing mental health challenges such as anxiety, depression,…
Congress should replace today’s program-by-program approach to value-based purchasing with a unified platform of expected medical and patient-reported outcomes, defined uniformly, risk adjusted or stratified uniformly, and used across all payers. For a quarter of a century, the US has graded health care primarily on process and documentation — whether a box was checked, a…