When physicians describe the forces reshaping medicine, they increasingly point not to a new device or a breakthrough drug but to the economics underneath their work. The move from fee-for-service to value-based payment is no longer theoretical. For a growing number of specialists, it is starting to feel personal. That change in perception is worth…
During 2025, the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS) announced seven new value-based payment models. Among these new models is the Ambulatory Specialty Model (ASM), which is specifically focused on improving efficiency in care for two chronic conditions—lower back pain and heart failure. Another new model, the Long-term Enhanced…
Despite its increasing use, artificial intelligence integration is lagging at healthcare systems and organizations across the U.S., according to a new survey from Arcadia. Fifty-two percent of respondents report that AI can fundamentally transform healthcare in correct applications, though about half (53%) of AI insights are “only partially embedded” into decision-making processes and only 14% report full…
Download Slides How Predictive Prevention Can Help CAHs Extend Care, Reduce Burnout, and Improve Value-Based Performance Rural hospitals face growing pressure from staffing shortages, chronic disease, and rising value-based care demands. This webinar explores how predictive prevention, automation, and continuous patient engagement can help Critical Access Hospitals extend care beyond their walls, reduce avoidable…
ABSTRACT Objectives: To examine whether the growth of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) and Medicare Advantage (MA) penetration was associated with changes in health care use among commercially insured populations. Study Design: Observational study using claims data. Methods: Using Health Care Cost Institute claims data (2015-2019), we conducted a repeated cross-sectional study of 13,041,197…
Download Slides In this 2026 measurement year, CMS’s sociodemographic status (SDS) risk adjustment is changing how medication adherence is measured, who you need to focus on, and why it matters more than ever. One in eight Medicare beneficiaries qualifies through disability rather than age, and this population underperforms across all three adherence measures by…
Nephrology occupies a uniquely strategic position in value-based care. Few specialties sit so directly at the intersection of clinical complexity, rising utilization, and outsized healthcare spend. Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are among the most resource-intensive conditions in Medicare, making kidney care one of the clearest opportunities for specialty-driven value creation….
When I think about what defines high-quality health care, I don’t start with a single visit or a specific service. I start with a broad view of the full care experience: how care is delivered over time, across settings and among care teams. High-quality care is built through coordination, prevention and a deep understanding of…
Medicare’s unprecedented and unpredictable spending growth in recent years is penalizing clinicians who have been most effective at slowing cost growth and improving care. The Accountable Care Prospective Trend (ACPT) in the Medicare Shared Savings Program (MSSP) could cost accountable care clinicians more than $700 million in lost shared savings for care delivered in 2025….
For nearly all acute care hospitals in the United States, a new mandatory payment model is on the horizon. The Centers for Medicare and Medicaid Services (CMS) has proposed the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, a mandatory, nationwide, episode-based payment model for lower extremity joint replacements (LEJRs) in Medicare fee-for-service (FFS). If…