I spent most of my space in last week’s blog post thanking AHIP for saving the annual progress report on alternative payment model (APM) adoption from the clutches of the Centers for Medicare and Medicaid Services (CMS) and the Make America Healthy Again movement. I spent the balance of the post on some interesting data from the…
CMS continues to bring accountable care to more people with Medicare in 2026, expanding the benefits of high-quality, whole-person health care to achieve better health outcomes for millions of older Americans. As of January 2026, 14.3 million Medicare beneficiaries are estimated to receive care coordinated by Accountable Care Organizations (ACOs), up from 13.7 million in…
Download Slides Specialty costs have long been a gnarly issue for ACOs, which currently have no ability to either steer or manage specialty costs. But Change is in the air, and it’s coming through ASM and TEAM, two large-scale specialty care risk payment models. Both payment models require referrals to primary care physicians for…
Health systems are responding to fragmented behavioral healthcare delivery in different ways: expanding telepsychiatry in rural states, building pediatric health hubs that integrate mental and physical health on one campus, launching behavioral health urgent cares, and investing in navigators and data infrastructure to keep patients connected after discharge. In West Virginia, the access challenge is…
The Medicare Advantage (MA) Star Ratings program is undergoing a fundamental shift. Instead of primarily rewarding health plans’ operational compliance and administrative performance, the focus is moving toward measurable clinical outcomes and member experience. As a result, medication management will increasingly influence both Star Ratings performance and financial outcomes, making it a critical area for…
Submitting data to CMS is one of those tasks that sounds straightforward until you realize how many moving parts are involved. A missed measure, an incomplete record, or a data entry mistake can drag down your MIPS score and leave money on the table. The good news is that a solid internal audit can catch…
Physicians told Becker’s that the next major shift in medicine won’t be a new device or breakthrough drug, but the accelerating shift from fee-for-service to value-based purchasing. Cost pressures, patient frustration and employer fatigue are converging in ways that may force a structural reset in how physicians practice and get paid, several said. Steven Rich, MD, a…
Making any additions or changes to your organization requires a lot of very careful planning and observation. While these additions/changes can be a huge benefit, opening up your organization to implement them can also cause a lot of problems. It can introduce new weak points for cybercriminals, it can cause friction with your existing systems,…
Download Slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…
Download slides Staffing your care gap closure efforts can be extremely difficult. This is due to the massive staffing shortage in healthcare today, tighter budgets, and a lack of management capacity. We discovered a novel workforce that is cost effective, large in size, and excited to start contributing to the healthcare system today! In…