RECORDED WEBINAR: Preventing Avoidable ED Visits: How Predictive Analytics Transforms Utilization Management in Value-Based Care

Garrett SchmittNo Comments, , ,

 Download Slides Emergency department utilization is one of the most powerful cost accelerators in value-based care arrangements. For ACOs, Medicare Advantage organizations, and provider groups operating under downside risk, preventable ED visits can quickly erode shared savings and destabilize financial performance. The challenge is not simply managing ED use after it occurs- it is…

How AI-driven functional precision medicine unlocks personalized cancer therapy

Garrett SchmittNo Comments, , , ,

Despite decades of progress in oncology, ranging from molecular diagnostics to targeted therapies, cancer remains one of medicine’s most complex and costly challenges. While genomic sequencing and AI-assisted analytics have improved disease classification, biomarker identification, and the discovery of drugs that may help, most patients are still treated using standardized protocols driven by population-level data rather…

Why Thyme Care Succeeds Where Value-Based Care Has Fallen Short

Garrett SchmittNo Comments

Key Takeaways Persistent underperformance of prior oncology VBC models reflects failure to measurably improve outcomes while lowering total cost, sustaining skepticism despite ongoing urgency to redesign care delivery. Population-based infrastructure leveraging claims, HIE feeds, onboarding assessments, ePROs, and predictive modeling enables risk stratification and earlier intervention to prevent avoidable ED use and admissions. Value-based care…

2025 Medicare FFS catheter billing anomalies and ACO implications | Milliman MedInsight

Garrett SchmittNo Comments,

While reviewing claims data patterns in quarter three (Q3) of 2025, Milliman observed a significant increase in paid amounts for claims billed under Healthcare Common Procedure Coding System (HCPCS) code A4352—intermittent urinary catheter; coudé (curved) tip, with or without coating (Teflon, silicone, silicone elastomeric, or hydrophilic, etc.), each—that deviates from historical trends and could have…

Value-based care practices shift the ‘center of gravity’ of healthcare to prevention and early recognition of disease, says Jaewon Ryu, M.D., J.D., CEO of Risant Health

Garrett Schmitt

In the third segment from an extensive video interview with Managed Health Executive, Jaewon Ryu, CEO of Risant Health, discusses the role of prevention and early detection in value-based care. In Ryu’s view, the role is definitional. “Earlier recognition and treatment of disease is what we’re talking about when we talk about value-based care,” says Ryu….

Will The New CMS ACO Model LEAD To Better Care For High-Need Medicare Beneficiaries?

Garrett Schmitt

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…

Why ACOs Should Create High-Performance Specialty Networks

Garrett Schmitt

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…