One of the biggest disconnects in Medicare value-based care is that the architecture of value-based programs run by the Centers for Medicare and Medicaid Services (CMS) has not caught up with how health systems actually bill. More specifically, there’s a mismatch between the organizational unit CMS uses to administer accountable care and the way modern…
Value-based care is conventionally classified as an alternative payment model. That classification mistakes the output for the system. ost value-based care (VBC) arrangements do not compensate providers for value at the time value is produced. They establish a contractual methodology under which the economic consequences of care are measured, reconciled, and settled long after the…
Recently, the Centers for Medicare & Medicaid Services has accelerated a fundamental redesign of Medicare value-based care through a new wave of models that are reshaping how organizations manage surgical episodes, chronic conditions, ambulatory specialty care, and population health. This transformation extends beyond hospitals and health systems, impacting physician groups, specialists, post-acute providers, and community-based…
Download Slides With Comprehensive Care for Joint Replacement Expanded (CJR-X) set to launch January 2028, every eligible acute care hospital in the country is facing a new reality: mandatory bundled payments across a full 90-day episode window for joint replacement procedures. This is part of a broader and accelerating shift — CMS already made…
AI will “turbocharge” medical billing and drive up costs in the short term, CMS Administrator Dr. Mehmet Oz warned Wednesday. But he said the pain is worth it for long-term savings. CMS Administrator Dr. Mehmet Oz delivered a candid assessment of artificial intelligence’s impact on healthcare costs Wednesday: It’s going to get worse before it…
Amid growing public debate over how best to analyze spending on MA versus traditional Medicare, Dr. Amol Navathe stepped into the lion’s den to defend MedPAC’s work. The leader of an influential congressional advisory group is defending its estimates of Medicare Advantage overpayments amid growing controversy over how to best analyze spending in the privatized Medicare…
Download Slides Quality reporting is a requirement for participants in ACOs, MIPS and other Alternate Payment Models. However, despite its value, quality reporting is often seen as a compliance exercise, rather than an opportunity to measure and improve quality. This short-term approach costs organizations (literally) when actionable insights go unrecognized, resulting in high-cost utilization…
New tracks broaden the reach of a model in which outcome-aligned payments, referral strategy and provider co-management are key areas of consideration. CMS continues to put weight behind the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a 10-year initiative to apply value-based payment and digital solutions to chronic disease management. The agency announced…
Download Slides Clinical accuracy is the foundation of value-based care, but recent, high-profile enforcement actions have shown how much is at stake when the focus turns from delivering great care to optimizing coding. How can physician groups, ACOs and health systems capture true patient acuity without crossing into upcoding? Join Connective Health for a…
Stephanie Carlton, CMS’ deputy administrator and chief clinical AI officer, said CMS will soon roll out an ‘Investing in Health Outcomes Pledge’ Over the past few years there have been efforts to streamline Medicaid quality measures and start to move to measures that matter in terms of outcomes. During a recent Manatt webinar, Stephanie Carlton,…