Modern medicine is more advanced than ever, yet clinical care still leans heavily on what is, in practice, informed guesswork. Doctors make the most probable diagnosis, select the therapy most likely to help, and adjust only when outcomes fall short. To further complicate matters, one-half of patients with chronic diseases do not take their medications as…
You cannot control CMS raising cut points. But you can control how you respond. Changes are happening to how Medicare Advantage plans are measured for medication adherence. Starting in measurement year 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three Part D adherence measures: diabetes medications, RAS antagonists, and statins. What’s Actually…
Download Slides Most care teams receive ADT feeds that are incomplete, delayed, and missing critical context — making it difficult to know how and when to act. This webinar focuses on how to overcome incomplete ADT feeds and determine how and when to engage high-risk members. Leaders from Avery Telehealth and Connective Health will…
The CMS target year for value-based care is 2030, with a goal for 100% of Traditional Medicare beneficiaries and the majority of Medicaid beneficiaries to be in an accountable care relationship, focusing on quality outcomes and cost efficiency over service volume. 2025 reports and surveys showed a clear turning point for value-based care as model…
Enhanced ACA premium tax credits expire Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. Congressional efforts to extend the subsidies have stalled, with neither a Democratic three-year extension proposal nor a Republican alternative focused on HSAs passing the Senate. A House vote on extending the subsidies could still happen in early…
CMS has announced the launch of its newest accountable care organization model with the goal of providing a better way for primary care physicians and specialists to collaborate more closely to deliver coordinated care for patients, the American Medical Association reported Dec. 22. Here are five things to know about the new program: 1. The “Long-term Enhanced…
Bundled payments are increasingly used worldwide, yet long-term evidence remains limited, particularly in maternity care. This study evaluated five-year changes after bundled payments in maternity care in the Netherlands. Using a difference-in-differences design and 2008–21 nationwide data, we compared 22,307 pregnancies across six regions that adopted bundled payments in 2017 with 69,496 pregnancies in twenty…
Health systems and payers have invested heavily in predictive analytics — readmission risk, care-gap likelihood, and deterioration indices. Yet in many organizations, these insights remain stranded on dashboards. Without a mechanism that translates prediction into action, clinical teams face alert fatigue, slow follow-through, and muted outcomes. This article summarizes evidence from multi-site deployments (2023–2025) of agentic…
The Centers for Medicare and Medicaid Innovation has released its latest accountable care organization model, which is scheduled to launch at the conclusion of ACO Reach next year. The LEAD (Long-term Enhanced ACO Design) Model is expected to appeal to a broader mix of healthcare providers, including those with specialized patient populations. It is also…
Dive Insight: In 2023, ACO REACH replaced the previous direct contracting arrangement, wherein accountable care organizations take on risk to care for seniors in traditional Medicare. Despite tweaks by the CMS over ACO REACH’s tenure — most recently, regulators modified how benchmarks and risk scores are measured — participation has been underwhelming, with many providers electing not…
Payers and providers are locked in an “AI arms race” over coding and claims, but some industry leaders are acknowledging the battle may be a distraction from providing patient care. “The bots battling the bots is a real thing,” Sachin Jain, MD, SCAN Group president and CEO, told Becker’s. “We’re spending all this effort trying to…
If TEAM has your hospital searching for an evidence-based toolkit to improve surgical outcomes and reduce recovery time, participating hospitals and their surgical teams should pay heed to ERAS (Enhanced Recovery After Surgery) protocols. The guidelines are tailored to more than twenty types of surgery as well as anesthesia and intensive care. They have been successful…