Accountable care organizations (ACOs) were created to improve quality and reduce unnecessary costs in Medicare by aligning providers’ financial incentives with patient outcomes. A central part of that mission is helping the federal government identify and reduce waste, fraud, and abuse. Unlike traditional fee-for-service Medicare, ACOs are rewarded for delivering high-value care, which gives them…
On July 16, 2025, the Centers for Medicare and Medicaid Services (CMS) released a Notice of Proposed Rule Making (NPRM) for CY 2026. The proposed rule indicates that CMS wants to accelerate risk within its programs with the expectation that doing so will drive better results. However, many entities are not ready, and the current quality…
Download Slides Less than half of diabetics get their annual eye exam—and up to 70% never complete referrals. Join Dr. Brett Bielory to learn how AI-enabled screening and referral automation empower Health systems, Payers, ACOs, Specialists and PCPs to close gaps, improve outcomes, and boost quality scores. Speakers:Brett Bielory, MD – Glassman Eye Associates,…
Experts believe value-based care won’t ever reach scale unless fundamental barriers are addressed — including voluntary models, misaligned payer incentives, excessive metrics and weak employer engagement. The way healthcare is paid for is one of the most powerful levers shaping the future of the industry. Reimbursement structures determine which treatments are offered, how clinicians spend…
On Tuesday afternoon at the MGMA Leaders Conference 2025 in Orlando, Florida, an expert panel, moderated by Shane Jackson, MBA, president of Jackson Healthcare, wrestled with deceptively simple question: Is medicine still a calling? The question was first posed in a joint report published by the two organizations earlier this year. The panel was comprised of Tony Stajduhar, president…
In 2023, direct spending within orthopedics, oncology, cardiology, women’s health, behavioral health and nephrology made up 38% of all total medical spending, and 68% of total commercial and Medicare spending, according to a July 22 report from consulting firm McKinsey & Co. Here is how Medicare and commercial spending changed from 2020 to 2023, by specialty: Full…
Companies operating under the payvider business model, such as VNS Health and Humana Inc. (NYSE: HUM), have pointed to the ability to provide a more integrated care experience, as well as an increased engagement with value-based care, as a key differentiator. For Humana, the clearest example of leveraging its integrated care to engage in value-based care…
Download Slides As medical practices, we are dedicated to the health and wellness of the panels we serve. We set goals, implement actions, and assess outcomes to best meet patients’ needs. But what about our care team’s outcomes and needs? Now more than ever, with the challenges of employee retention, financial stressors, competing priorities,…
For years, value-based care has remained a central debate in the health care industry amid the ongoing push to improve outcomes while controlling costs. Traditional fee-for-service models have revealed their limitations, such as data fragmentation, misaligned incentives, regulatory complexity, technology gaps, and an overall cultural hesitancy to adopt to a new business practice. These challenges…
Rewards tied to improved hospital readmission rates were so small and so variable from year to year that they likely contributed to a “lack of effectiveness” for a key nursing home financial incentive program. The Skilled Nursing Facility Value-Based Purchasing program is the Centers for Medicare & Medicaid Services’ largest use of financial incentives to…