A consistent theme is emerging in my conversations with Medicare Advantage and accountable care executives. Many organizations have worked the familiar levers — coding accuracy, pharmacy, post-acute utilization, network performance — and are now looking for the next meaningful source of clinical and financial improvement. One answer is already inside their attributed population; people living…

Despite ongoing improvement, stakeholders highlight need to modernize how accountable care models are evaluated The 115 accountable care organizations that participated in ACO REACH in Performance Year 2024 generated $2.5 billion in gross savings, with $988.3 million returned directly to the Centers for Medicare and Medicaid Services (CMS), for the care of 2.5 million seniors,…

CMS’ Advancing Chronic Care with Effective, Scalable Solutions model launched July 5, testing whether paying organizations for outcomes — rather than specific services — can expand access to technology-supported chronic care. Behavioral health is one of four clinical tracks, alongside musculoskeletal pain and two cardio-kidney-metabolic tracks split by disease stage, putting depression and anxiety management on equal footing with…

When CMMI released the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, it did something the Innovation Center rarely does this narrowly. It built a payment experiment around specific measured outcomes. CMMI usually builds population-based payment incentives and bundled payments, with specific components around highly prevalent chronic conditions layered in rather than made the…

For the longest time, physician practices have operated on a fee-for-service model that pays for visits, tests and procedures. We’re finally seeing a shift toward more value-based care models that base compensation on the quality of care and a patient’s longevity of health, a shift that I believe is better for all parties involved. The U.S. Centers for…

Health care leaders have long viewed fraud, waste, and abuse as compliance issues. But as more provider organizations accept financial risk through accountable care and other value-based arrangements, fraud, waste, and abuse are no longer simply compliance concerns. They are increasingly financial performance risks that can directly affect benchmark attainment, shared savings results, and care…

Sustainability has become less about cutting costs and more about redesigning how healthcare delivers value. Becker’s asked several health plan leaders how they’re thinking about long-term sustainability, and the responses point to a shared shift away from volume-driven models toward outcomes, accountability, and member-centered design. From shifting social health programs toward measurable, evidence-based interventions to redesigning the…

In our last four articles, we have focused on payment models and infrastructure to establish how ACOs can be central to Value-Based Care, even under specialty models. Now it’s time to shift our focus back to what the payment models set out to do: improve patient health and rationalize costs. We cannot lift up patient…