CMS and state Medicaid agencies should consider several factors related to the ACO LEAD (ACO Long-Term Enhanced Design) model’s proposed test of integrated Medicare-Medicaid ACOs. Dual-eligible beneficiaries account for a disproportionate share of Medicare and Medicaid spending owing to their complex medical, behavioral, and social needs. Care for this population presents multiple challenges, in part, because Medicare…

The CMS Brief (August 2026): Tracking Payment Reform, Greater Accountability, and the Next Phase of Value-Based Care Every month, CMS releases dozens of announcements, policy updates, proposed rules, and operational guidance documents. Some generate headlines. Others quietly signal where healthcare policy, payment reform, and value-based care may be heading next. The CMS Brief is designed to help…

Fifty-three percent of American adults feel as though they either have “not too much” or no control over the use of artificial intelligence in their healthcare, a new survey found. Moreover, 63% of respondents polled by the Pew Research Center report that they would like more say over whether AI is used in their care….

Here’s how finance leaders can evaluate AI investments in revenue cycle management before committing budget, and the risk exposure most vendor pitches leave out. Every healthcare CFO’s inbox now has an AI-in-RCM pitch in it. The promises are consistent: lower denial rates, faster collections, leaner overhead. What’s inconsistent is the due diligence behind the decision…

Litigation should not be the strategy to achieve Star Rating reform. It is the alarm, not the repair. Over the past two years, one health plan after another has taken the federal government to court over its Medicare Advantage quality scores—and won. UnitedHealthcare, Centene, Elevance Health, Alignment Health, and our own SCAN Health Plan have…

Dive Brief: Nearly half of physicians employed by corporations feel pressured to prioritize patient volume over care quality, according to a new survey of 1,000 doctors from a physician advocacy group. Additionally, 63% of physicians say their employers have policies that make it difficult to refer patients outside their network, and 59% say they face pressure to…