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…
Download Slides By creating mandatory, two-sided risk models, CMS has put specialists on notice: they will be held accountable in CMS’s efforts to control Total Cost of Care. The Transforming Episode Accountability Model (TEAM) will focus on procedures, while the Ambulatory Specialty Model (ASM) targets specialists managing specific conditions. This webinar will look on…
One of the largest and most significant changes to specialty care payments in Medicare commences in January. TEAM (Transforming Episode Accountability Model) is poised to put hospitals at risk for total costs of care for the highest cost Medicare surgical episodes, including Coronary Artery Bypass Graft (CABG), Lower Extremity Joint Replacements (LEJR), major bowel procedures,…
“Medicare patients in accountable care organizations (ACOs) face unique challenges, from advanced illness to fragmented medical records”, says Tom Kim, MD, chief medical officer, Sound Long-Term Care Management. How does this population differ from “traditional” ACO populations, and what specific challenges does that bring in terms of care, cost, and quality? It’s a really good…
Payers and providers have long had ups and downs in their relationships, even before the Affordable Care Act. But prior authorization and data interoperability demands, coupled with patient volume and clinical documentation needs, mean payers and providers feel under more pressure than ever before. Value-based care (VBC) offers a care model alternative to the traditional…
After the longest government shutdown in U.S. history (one triggered by battles over health care funding) the core issue remains unresolved. Neither political party has produced a durable solution. The Centers for Medicare and Medicaid Services (CMS) projects U.S. health care spending will reach nearly $9 trillion by 2035, consuming 20 percent to 22 percent of GDP….