In North Dakota, references to the Rough Riders — a famed cavalry in the 1898 Spanish-American War — abound. The name graces hotels, grocery stores, and golf tournaments and has become a shorthand symbol of rugged individualism, bravery, and the willingness to act. A mix of cowboys, ranchers, Native Americans, and athletes from Ivy League…

Accountable care organizations (ACOs) have become an effective tool for Medicare to generate savings and catch health care fraud, said two advocates who described their firsthand experience with the model. Aisha Pittman, M.P.H., senior vice president of government affairs at the National Association of Accountable Care Organizations (NAACOS), and Katie Boyer, M.P.P.A., director of policy and government…

Population health management (PHM) is a data-driven approach that ACOs use to improve outcomes and lower total cost of care for a defined population by identifying risk before it becomes utilization, coordinating care across settings, and addressing the clinical and social factors that drive spending. For accountable care organizations (ACOs), PHM is not a philosophy….

The country’s underinvestment in primary care means missed opportunities to catch chronic disease early and help patients change unhealthy habits before those become costly, said the leader of Medicare’s Innovation Center. “We underinvest in primary care at the current prevailing payment rates,” said Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI)….

CHCs have historically kept communities healthy quietly, but their work is undervalued and undercoded. Adopting value-based care strategies, like annual wellness visits, can make their efforts visible, ensuring they continue to serve vulnerable populations effectively. So much of the work done in community health centers can feel invisible. I’ve spent my career working in and…

The Trump administration is proposing sweeping changes to Medicare payment and value-based care programs that it says will expand accountable care, modernize physician payment, and help shift the healthcare system toward prevention rather than treatment. On Tuesday, the Centers for Medicare and Medicaid Services issued Medicare Part B payment policy changes for physicians under the…

The last two years have dramatically strengthened the ACO role in providing accountable care. New CMS specialty payment models—TEAM, ASM, and the proposed CJR-X—each include specific provisions for ACO coordination and referrals, extending the ACO’s reach deep into the specialty care continuum. LEAD, the new long-term ACO model with prospective payments, has redefined the future of…

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…