The healthcare industry’s landscape shifted dramatically with the implementation of the Transparency in Coverage (TiC) Final Rule. For compliance professionals navigating this regulatory terrain, understanding both the letter and spirit of these requirements has become essential – not just for avoiding penalties, but also for leveraging transparency as a strategic advantage. The Regulatory Foundation The…
A decade ago, the federal government launched its large-scale Medicare Access and CHIP Reauthorization Act (MACRA) in an attempt to move more physicians into value-based care to rein in exploding costs and improve care. In July, Medical Economics will release the second edition of Medical Economics Insider featuring an in-depth look at how successful MACRA has been and what…
Download Slides Are you prepared for heightened scrutiny from the Centers for Medicare & Medicaid Services (CMS)? CMS is dramatically amplifying its audit efforts, with a renewed focus on Medicare Advantage plans and Risk Adjustment Data Validation (RADV) audits. This is not just another day at the office—CMS is expanding its audit workforce, increasing…
Download Slides We are entering into a period of scarce health care resources, with less funding to support new developments but higher focus on cost control. Many reimbursement vehicles, both governmental and private health plans, will adopt risk-based reimbursement. How do providers manage the transition to risk payment models? Is it still prudent to…
Women primary care providers (PCPs) treating Medicare patients in a value-based care setting have equal or better patient outcomes than men PCPs in the same setting, despite having the same overall patient satisfaction rating, according to a recent study sponsored by agilon health, published May 16 in JAMA Health Forum. Women PCPs ranked higher than their men counterparts…
The last time The American Journal of Managed Care (AJMC) hosted a meeting in Princeton, New Jersey, was 2014, as millions of Americans were gaining health coverage under the Affordable Care Act—some for the first time in their lives. Across health care, people were trying to grasp a new concept called value-based care, which focused on delivering…
As the second half of 2025 approaches, hospitals and health systems are taking stock of their annual quality improvement initiatives and pushing forward. Three healthcare leaders shared with Becker’s the quality metrics they are tracking most closely, including efficient discharges and fall prevention. Question: Looking ahead to the second half of the year, what is one specific quality…
What’s now VBC is growing, not shrinking There’s a lot happening in healthcare right now. A new administration at the helm creates uncertainty, provider organizations face slim margins, and health plans have high medical expenses. These recent developments in the industry have leaders concerned about the future of risk-based models. But for all the potential…
Accountable care organizations (ACOs) are a significant innovation in health care delivery and payment. ACOs, formed by various health care providers, including acute care hospitals, expanded through commercial health plans and Medicaid agencies even before Medicare ACOs grew under the Affordable Care Act. CMS launched the Medicare Shared Savings Program (MSSP) and Pioneer ACOs in…
Download Slides Analytics only create impact when they lead to action — but many healthcare organizations struggle to translate dashboards into true change. The problem isn’t the data. It’s the lack of operational pathways to bring insights into the day-to-day work of clinicians, managers, and leaders. In this session, hear how CareJourney and Arcadia…