For decades, policy makers have struggled to improve care and control costs for medically complex and socially vulnerable populations, particularly individuals dually eligible for Medicare and Medicaid. Dual-eligible beneficiaries experience high rates of chronic illness, disability, and unmet social needs, and they account for a disproportionate share of Medicare and Medicaid spending. Despite sustained efforts to shift payment…

Specialty costs have been a difficult problem for ACOs, driving a huge portion of total costs in specialty-driven services of all kinds: physician visits, hospital admissions, procedures, and treatments. ACOs have argued they don’t have the tools needed to combat costs. But that is not quite true. We argued in a recent webinar that ACOs have the…

Behavioral health has entered a new era of accountability. Proof, measurements and improved outcomes are taking on renewed importance during a year that many anticipate will bring heightened scrutiny and uncertainty in the regulatory environment. But a focused pivot from growth to proof does not mean that 2026 will be a year of slowed or…

Health Affairs’ Jeff Byers welcomes Brown University’s Andrew Ryan to the pod to discuss his recent Forefront article that explores whether value-based payment and managed care can lead to addressing the core drivers of spending. Full Article

Primary care is critical for population health, health equity, and the overall efficiency of the health care system.1 It also has been consistently associated with improved life expectancy and reduced health care disparities. The four defining features of high-functioning primary care are: accessibility comprehensive care for most patient problems continuity of care over time coordination of…

I spent most of my space in last week’s blog post thanking AHIP for saving the annual progress report on alternative payment model (APM) adoption from the clutches of the Centers for Medicare and Medicaid Services (CMS) and the Make America Healthy Again movement. I spent the balance of the post on some interesting data from the…