Value-based payment (VBP) — which ties health care reimbursement to quality and cost outcomes — has gained traction across the health care sector. Primary care providers participating in VBP arrangements have often performed well, likely due to their focus on prevention and cost-efficient care. However, community health centers (CHCs), which provide primary care to more than…

There is an eagerness across the behavioral health industry to transition from fee-for-service into value-based contracts. But, at times, this urgency can actually be a hindrance instead of a help, industry insiders recently explained at the Behavioral Health Business VALUE conference. Crafting value-based care infrastructure, understanding how and what to measure and defining the mechanisms…

Behavioral Health Business: I’m going to introduce our panelists here. I’ve got Michael Frisby, the Chief Growth Officer at Sandstone Care; Melissa McCarthy, Co-founder and Managing Partner at The Reprieve; and Lindsay Beasley, Director of Solutions Engineering at Sunwave. I’m going to sit down and enjoy the conversation with you all. Take it away. Michael Frisby: Great….

Aledade and other accountable care organizations are pressing the Centers for Medicare & Medicaid Services to correct what they say is a major misstep in a financial benchmark model that could significantly reduce their earnings and possibly force some practices out of value-based care and discourage others from joining. The controversy centers on CMS’s Accountable…

In 2024, the Centers for Medicare and Medicaid Services (CMS) implemented important changes to how spending targets, known as benchmarks, are set in the Medicare Shared Savings Program (MSSP) for accountable care organizations (ACOs) entering new five-year agreement periods. Among these, CMS introduced an Accountable Care Prospective Trend (ACPT) into the formula for updating MSSP…

The Centers for Medicare & Medicaid Services (CMS) revealed several updates to the ACO REACH program in 2026, though the model’s long-term future remains unclear. The CMS said it is making changes to the model based on preliminary data on 2023 performance, which found that standard accountable care organizations saved $197.5 million in aggregate that…

The Center for Medicare & Medicaid Innovation (“CMMI”) has announced a new strategy for establishing payment systems that incentivize healthier lives through a focus on three key pillars: (1) promoting evidence-based prevention; (2) empowering patients to achieve their health goals; and (3) driving choice and competition. This strategy includes several positives for providers participating (or…

Challenges to the Biden-era parity rule, reductions to key behavioral health-focused agencies and looming Medicaid cuts are changing the game for how behavioral health providers operate. Still, the preventative care push coming from the top is building a new race for behavioral health professionals to run, experts told Behavioral Health Business during a March VALUE event. “Whether the funding comes or not, is…