Abstract This Perspective discusses the fiscal challenge facing Medicare and how that challenge may be differentially met by fee-for-service, accountable care organization (ACO), and Medicare Advantage (MA) payment systems. The non-MA part of Medicare includes both fee-for-service and ACO payment systems and is sometimes referred to as traditional Medicare. Fee-for-service, although in need of reform,…
The best decision will always be an informed decision – especially in healthcare. The more data that your providers have about you and your health, the better they can care for you. The only problem in this case is that you don’t receive all of your healthcare at the same location from the same doctor….
Download Slides Did you know that MSK conditions affect over 50% of adults and cost the health care system an estimated $420 billion annually— that’s more than diabetes, heart disease or any other chronic condition that plagues our population. And, in addition to the surgeries, PT, imaging and medication costs, you can add another $83B…
The AMA has joined dozens of other physician and health care associations and hundreds of accountable care organizations (ACOs), health systems, hospitals and physician practices in calling on Congress to take steps to sustain the nation’s transition to value-based care. Congress, the AMA and others said, should prioritize extension of Medicare’s advanced alternative payment model…
Heads up! CMS’s Proposed 2026 PFS Rule introduces a new payment model for tackling specialty care and costs in traditional Medicare. Clearly not a snap decision, Ambulatory Specialty Model (ASM) has been cooked until well-seasoned and served up in 210 pages of the proposed Rule. Unlike a typical Notice from the CMS Innovation Center that initiates many Value-Based Care…
The national conversation around primary care — for both the private and public sectors — is experiencing a profound shift towards prioritizing value, prevention and outcomes over wasteful spending. This transformation comes at a critical time. Despite the shortage of providers the U.S. is now facing, investment in primary care saves money and leads to better outcomes by reducing the…
As the US healthcare system speeds up its pivot from volume to value, one crucial tool, which is often overlooked in mainstream discourse, is slowly but surely going through a necessary shift—the current procedure terminology, CPT code set. Developed as well as maintained by the American Medical Association (AMA), the CPT code set has long…
Specialty care has emerged as a major driver of increasing US healthcare spending. Specialty care focuses on specific body systems or diseases, such as orthopedics or oncology. Primary care, by contrast, covers a range of health services addressing common illnesses and prevention. Payers and health systems are seeking ways to improve patient experiences and outcomes…
Download Slides Initial and ongoing engagement is one of the toughest challenges in value-based care. Is your outreach too little—or too much? This webinar explores how to strike the right balance using multi-pronged strategies that drive outcomes without overwhelming patients. Learn how to stay nimble, personalize engagement, and avoid fatigue. Visit the Avery Telehealth…
Summer is here, and the heat is on: barbeques, beaches, and the 2026 CMS Physician Fee Schedule Proposed Rule. Throughout 1,803 pages, CMS is going after the total cost of care in the MIPS and APM tracks of the Quality Payment Program (QPP). These proposed updates and the creation of a surprise new (and mandatory!) Alternate Payment…