As the US healthcare system speeds up its pivot from volume to value, one crucial tool, which is often overlooked in mainstream discourse, is slowly but surely going through a necessary shift—the current procedure terminology, CPT code set. Developed as well as maintained by the American Medical Association (AMA), the CPT code set has long…
Specialty care has emerged as a major driver of increasing US healthcare spending. Specialty care focuses on specific body systems or diseases, such as orthopedics or oncology. Primary care, by contrast, covers a range of health services addressing common illnesses and prevention. Payers and health systems are seeking ways to improve patient experiences and outcomes…
Download Slides Initial and ongoing engagement is one of the toughest challenges in value-based care. Is your outreach too little—or too much? This webinar explores how to strike the right balance using multi-pronged strategies that drive outcomes without overwhelming patients. Learn how to stay nimble, personalize engagement, and avoid fatigue. Visit the Avery Telehealth…
Summer is here, and the heat is on: barbeques, beaches, and the 2026 CMS Physician Fee Schedule Proposed Rule. Throughout 1,803 pages, CMS is going after the total cost of care in the MIPS and APM tracks of the Quality Payment Program (QPP). These proposed updates and the creation of a surprise new (and mandatory!) Alternate Payment…
Is your Medicare Shared Savings Program (MSSP) ACO ready to tackle the complex world of electronic Clinical Quality Measures (eCQM) reporting? While some organizations consider building their own internal reporting capabilities, the reality is that aggregating data from multiple EHRs, ensuring measure compliance, and preparing submission-ready files requires significant expertise and coordination that many underestimate. eCQM reporting for MSSP…
The Center for Medicare and Medicaid Innovation (CMMI) has announced a refreshed strategy to promote evidence-based prevention, empower beneficiaries to achieve their health goals, and promote competition and choice in health care markets. Value-based payment (VBP) can advance that vision, but only if CMMI dramatically amplifies the will among provider organizations to fully commit to generating health…
What if a potent driver of value-based success isn’t found in your clinical programs but in the first few minutes your residents spend with your team? Long-term care is racing toward value-based care (VBC). You obsess over quality measures, satisfaction surveys and readmission rates. You invest in clinical pathways, technology and staff training. But when…
Last month, the Centers for Medicare & Medicaid Services (CMS) released its 2026 Medicare Advantage (MA) Rate Announcement, projecting a 5.06% average increase in payments to MA plans. That’s a notable jump from the 3.70% increase we saw in 2025. More than just a financial adjustment, this signals growing confidence in the Medicare Advantage model—and with…
The Trump administration proposed a sweeping physician payment rule on Monday that rewrites Medicare payment to comply with recently passed GOP tax and policy law — and decade-old healthcare legislation. The CMS’ proposed physician fee schedule for 2026 includes a base rate hike of 2.5%. The increase was a handout to providers in the controversial “One…
Integrating care for people dually eligible for and enrolled in Medicare and Medicaid remains a bipartisan policy priority. Because Medicare and Medicaid are administered and funded separately, most dual-eligible beneficiaries receive coverage through two distinct programs with separate budgets, which lack financial incentives to coordinate care. To address these misaligned payment incentives, much of policy makers’ efforts…