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From Fragmentation to Clarity: How Ambient AI Powers Value-Based Care

January 20, 2026Garrett Schmitt

As healthcare organizations deepen their investments in value-based care, one obstacle continues to stymie progress: incomplete visibility into the patient’s health status. The problem isn’t limited to a single source, such as claims data, though claims are often blamed. Rather, it’s the fragmented nature of healthcare data itself. Patient information is dispersed across a patchwork of…

Skin in the game: How accountable care can fight fraud while helping patients

January 14, 2026Garrett Schmittphysician burnout

Accountable care organizations (ACOs) aim to improve patient care by managing their conditions and maintaining access to affordable care. To do so, ACOs amass data about patient health and spending, and there’s a potentially positive side effect: ACOs can serve as watchdogs to guard against wasteful and fraudulent spending in health care. That has happened over…

Rethink the Essential Role of Primary Care Physicians in TEAM

January 14, 2026Garrett Schmitt

With TEAM’s focus on improving surgical recoveries and costs in major hospital-based surgeries, it’s easy to miss the importance of primary care physicians. But their role is essential for meeting TEAM’s objective to improve patient recovery and lower costs in the five major types of surgery covered by TEAM. And perhaps not in the way…

The post-acute problem: The biggest blind spot in value-based care

January 13, 2026Garrett SchmittNo Commentschange management strategy, gap analysis, healthcare technology, value-based care, vbc

When the Centers for Medicare & Medicaid Services (CMS) launched the Transforming Episode Accountability Model (TEAM) and the AIM for Health Equity and Accountable Care Growth (AHEAD) model, it wasn’t tinkering with policy at the margins — it was redefining what hospitals are accountable for. The new rules make one truth unavoidable: the hospital’s responsibility doesn’t…

From Early Detection to Targeted Therapy: How AI is Reframing Precision Medicine

January 9, 2026Garrett Schmitt

Modern medicine is more advanced than ever, yet clinical care still leans heavily on what is, in practice, informed guesswork. Doctors make the most probable diagnosis, select the therapy most likely to help, and adjust only when outcomes fall short. To further complicate matters, one-half of patients with chronic diseases do not take their medications as…

What SDS Risk Adjustment Means for Your 2026 Adherence Strategy

January 8, 2026Garrett SchmittCoding, HCC, MVPs, Risk adjustment coding

You cannot control CMS raising cut points. But you can control how you respond. Changes are happening to how Medicare Advantage plans are measured for medication adherence. Starting in measurement year 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three Part D adherence measures: diabetes medications, RAS antagonists, and statins. What’s Actually…

For TEAM Success, Collaboration Agreements Must Be a Win-Win for Specialists and Hospitals

January 8, 2026Garrett Schmitt

The new Transforming Episode Accountability Model (TEAM) targets the highest cost or volume surgeries in the Medicare program. While hospitals bear the financial risk, CMS has created a vehicle to align interests with other providers through Collaboration Agreements that can include financial incentives. How those are structured will be key to the successful alignment—or fracture—of the hospital’s…

RECORDED WEBINAR: Imagine Having Complete ADT Feeds with Actionable Data

January 7, 2026Garrett SchmittNo CommentsACO reporting, ACOs, APP, APP measures, eCQM, vbc, Webinar

 Download Slides Most care teams receive ADT feeds that are incomplete, delayed, and missing critical context — making it difficult to know how and when to act. This webinar focuses on how to overcome incomplete ADT feeds and determine how and when to engage high-risk members. Leaders from Avery Telehealth and Connective Health will…

Targeting 4 More Years and Scaling Value-Based Care Models in 2026

January 5, 2026Garrett SchmittBPCI, BPCI Advanced

The CMS target year for value-based care is 2030, with a goal for 100% of Traditional Medicare beneficiaries and the majority of Medicaid beneficiaries to be in an accountable care relationship, focusing on quality outcomes and cost efficiency over service volume. 2025 reports and surveys showed a clear turning point for value-based care as model…

How states are responding to expiring ACA subsidies

December 30, 2025Garrett SchmittCoding, HCC, Risk adjustment coding

Enhanced ACA premium tax credits expire Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. Congressional efforts to extend the subsidies have stalled, with neither a Democratic three-year extension proposal nor a Republican alternative focused on HSAs passing the Senate. A House vote on extending the subsidies could still happen in early…

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