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SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans

December 11, 2025Garrett Schmittalternative payment models, APMs

Key Takeaways: Unmet basic needs such as social determinants of health (SDOH) impede medication adherence, chronic disease control, and appointment attendance, lowering performance on blood pressure control, diabetes A1c, kidney health evaluation, hypertension management, medication adherence (triple weighted), and all-plan readmissions measures. Interventions such as medically tailored meals, food delivery, transportation support, and closed-loop referrals stabilize…

How AI Is Reshaping Emergency Departments

December 11, 2025Garrett Schmitt

Emergency departments (EDs) are under more pressure than ever. Apart from the growing patient volumes, staffing shortages, and increasing expectations to deliver safe, high-quality care, EDs are also a frequent destination for some of the most vulnerable patients, those transferred from skilled nursing facilities (SNFs) and other post-acute facilities. Too often, SNF patients arrive with…

RECORDED WEBINAR: AI Pitfalls That Value-Based Care Providers Need to Avoid

December 10, 2025Garrett SchmittNo CommentsACOs, AI, vbc, Webinar

 Download Slides Join us to learn how to harness AI for value-based outcomes—without falling into dangerous traps! As AI rapidly enters healthcare, value-based care (VBC) organizations face unique risks when adopting these technologies. This webinar highlights the most common AI pitfalls—including privacy violations, inaccurate outputs, biased or incomplete data, workflow disruption, and low clinician…

Expert Consensus on Essential Characteristics of Oncology Value-Based Payment

December 10, 2025Garrett Schmitt

ABSTRACT Value-based payment (VBP) models are increasingly adopted in oncology to promote high-quality, cost-effective, and patient-centered care. To identify essential characteristics of effective oncology VBP models, a modified Delphi process was conducted with 9 experts representing diverse oncology organizations. Panelists participated in 2 survey rounds and an in-person discussion, evaluating the importance and feasibility of key…

Solid data is essential to making AI and VBC work

December 9, 2025Garrett Schmitt

Good data is the lifeblood of good healthcare. Ensuring the right information is available to the right care team members at the right time is essential to delivering high-quality care. Two recent trends in healthcare are underscoring this fact. The first, unavoidably, is artificial intelligence. It is critical to have clean and well-governed to make…

RECORDED WEBINAR: Driving Shared Savings Through Regional Efficiency: Unlocking the MSSP ACO Benchmark with Wakely

December 4, 2025Garrett SchmittNo CommentsACOs, vbc, Webinar

 Download Slides Regional efficiency is the most influential factor in determining an MSSP ACO’s initial shared savings, yet most ACOs operate without understanding the providers that drive this efficiency. While CMS provides comparative data on membership, key benchmark variables like historical expenditures, risk scores and regional efficiency are only revealed once the performance year…

CMS announces new value based payment model for technology-enabled care

December 3, 2025Garrett Schmitt

The ACCESS Model is designed to expand tech-enabled care for Medicare beneficiaries with certain chronic conditions, aligning payments with outcomes for better patient health. What’s the impact? A Medicare model targeting conditions like hypertension, diabetes, chronic pain, and depression with scalable, tech-supported solutions. Providers, tech firms, and health systems gain new reimbursement pathways; applications open…

RECORDED WEBINAR: How AI Agents Can Power the Modern Value Based Team

December 3, 2025Garrett SchmittNo CommentsACOs, vbc, Webinar

 Download Slides In our last webinar “AI-Native Primary Care: Tactics to Thrive in Value-Based Care” we discussed the challenges faced by primary care practices, IPAs, and ACOs, and outlined a path forward. This one shows the “how.” We will discuss real examples of AI agents working across EHRs offloading routine admin work like risk…

Maturing in Risk: Unlocking Value Through MSSP Participation

December 2, 2025Garrett Schmitt

The Medicare Shared Savings Program (MSSP) is the largest federal initiative that promotes accountable care and value-based payment models. A central design feature of the program is its tiered approach to financial risk. ACOs generally begin in one-sided models and share in a portion of the savings generated but are insulated from losses if costs…

RECORDED WEBINAR: How Houston Methodist ACO is cracking the code on HCCs

December 2, 2025Garrett SchmittNo CommentsACOs, hospice, palliative care, vbc, Webinar

 Download Slides Houston Methodist Coordinated Care Medicare ACO is #1in Savings Per Patient for Academic Medical Centers. 98th percentile in Total Earned Savings = $50.4 million. 98th Percentile in Quality Nationally = 96. One of their leaders, Wajiha Waheed, Director of Finance and Operations, will join us to discuss HCC recapture tools and change…

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Recent Posts

  • SDOH Interventions and Managed Care Performance: A Roadmap for Health Plans
  • How AI Is Reshaping Emergency Departments
  • RECORDED WEBINAR: AI Pitfalls That Value-Based Care Providers Need to Avoid
  • Expert Consensus on Essential Characteristics of Oncology Value-Based Payment
  • Solid data is essential to making AI and VBC work
 
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