The explicit theme of the recent Centers for Medicare & Medicaid Services quality conference was, “Making America Health Again: Innovating Together for Better Health.” The implicit theme was, “Speak Softly And Carry A Big Stick,” as agency leaders made clear they intend to use the $1.2 trillion in provider payment they control to make value-based…
Download Slides ACOs are under immense pressure to close more care gaps, hit TOC windows, and drive preventive care—yet most teams are already stretched thin. This webinar breaks down how to scale patient engagement responsibly, using automation that’s transparent, governed, and designed to support (not replace) care teams. In this session, we’ll unpack the…
Download Slides Emergency department utilization is one of the most powerful cost accelerators in value-based care arrangements. For ACOs, Medicare Advantage organizations, and provider groups operating under downside risk, preventable ED visits can quickly erode shared savings and destabilize financial performance. The challenge is not simply managing ED use after it occurs- it is…
Despite decades of progress in oncology, ranging from molecular diagnostics to targeted therapies, cancer remains one of medicine’s most complex and costly challenges. While genomic sequencing and AI-assisted analytics have improved disease classification, biomarker identification, and the discovery of drugs that may help, most patients are still treated using standardized protocols driven by population-level data rather…
Key Takeaways Persistent underperformance of prior oncology VBC models reflects failure to measurably improve outcomes while lowering total cost, sustaining skepticism despite ongoing urgency to redesign care delivery. Population-based infrastructure leveraging claims, HIE feeds, onboarding assessments, ePROs, and predictive modeling enables risk stratification and earlier intervention to prevent avoidable ED use and admissions. Value-based care…
From its inception, accountable care policy has centered on primary care. Accountable care organization (ACO) programs have been designed and built on the premise that primary care clinicians and groups should anchor population health. This strategy has rationale. Primary care plays a critical role in both preventive and chronic care management in ways that are…
LAS VEGAS – The Medicare Shared Savings Program has been one of the most successful programs established by the Centers for Medicare & Medicaid Services to improve quality and save costs. The voluntary program was established through the Affordable Care Act 14 years ago as an alternative payment model that is the essence of value-based…
While reviewing claims data patterns in quarter three (Q3) of 2025, Milliman observed a significant increase in paid amounts for claims billed under Healthcare Common Procedure Coding System (HCPCS) code A4352—intermittent urinary catheter; coudé (curved) tip, with or without coating (Teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each—that deviates from historical trends and could have…
In the third segment from an extensive video interview with Managed Health Executive, Jaewon Ryu, CEO of Risant Health, discusses the role of prevention and early detection in value-based care. In Ryu’s view, the role is definitional. “Earlier recognition and treatment of disease is what we’re talking about when we talk about value-based care,” says Ryu….
For decades, policy makers have struggled to improve care and control costs for medically complex and socially vulnerable populations, particularly individuals dually eligible for Medicare and Medicaid. Dual-eligible beneficiaries experience high rates of chronic illness, disability, and unmet social needs, and they account for a disproportionate share of Medicare and Medicaid spending. Despite sustained efforts to shift payment…