The accountable care organization (ACO) model is shaping up to be the base that future value-based care models will be built on, with more than 50% of Medicare fee-for-service (FFS) beneficiaries being aligned with an ACO now. While there’s a lot of room for improvement in the ACO model, the Centers for Medicare and Medicaid…
In many accountable care organizations (ACOs), frontline physicians are under strong pressure to schedule Medicare annual wellness visits (AWVs) for every eligible patient. On paper, AWVs are framed as a cornerstone of value‑based care. In reality, for patients who already receive regular, well‑designed chronic care and follow‑up visits, a separate AWV can easily become cost‑ineffective. It adds encounters and expense without…
The Center for Medicare and Medicaid Innovation (known as the Innovation Center) accountable are organization (ACO) models, which pay providers based on outcomes rather than services provided, have demonstrated an ability to drive gross savings while maintaining or improving quality. However, net savings directly to taxpayers (via Medicare once payments to ACOs are included) have been…
For patients managing complex conditions like diabetes, care is rarely straightforward. Many are navigating multiple comorbidities, evolving symptoms, and treatment plans that require consistency over time. In this environment, clinical expertise is essential, but it is not enough on its own. Trust is what allows that expertise to translate into action. Research consistently shows that…
Download Slides The Long-term Enhanced ACO Design (LEAD) Model is the CMS Innovation Center’s newest Accountable Care Organization (ACO) focused model, set to launch following the conclusion of ACO REACH at the end of 2026. LEAD builds upon the CMS Innovation Center’s earlier accountable care work and utilizes improved benchmarking to appeal to a…
The days of pharmacy’s financial survival hinging almost entirely on dispensing volume are numbered. For forward-thinking pharmacies willing to embrace value-based care, this shift represents one of the biggest opportunities the profession has seen in decades, impacting both clinical services and financial sustainability. “My best answer is [value-based programs are] coming regardless,” said Kevin Day,…
Hemab Therapeutics and Seaport Therapeutics are the newest biotech companies to join the public markets, each with an upsized IPO. According to IPO research firm Renaissance Capital, April was the biggest month for biotech IPO proceeds in more than five years. The biotech IPO window looks like it’s reopening. This past week closed with three…
The year 2025 wasn’t easy for most ACOs struggling with the sudden transition to data aggregation. In fact, it was a trial by fire. ACOs joined the modern era of quality reporting in 2025 with APP (APM Performance Pathway) Reporting, which spurred aggregation from multiple practice systems and patient matching across the ACO. This required…
In time, value-based care will come to hospices, and they must be ready, according to Kent Anderson, CEO of Ohio’s Hospice. In this environment, scale will be key, as will a need to better understand the needs and objectives of referral partners, Anderson told Hospice News. He also leads Metta Health, a revenue cycle management…
Hard to resist the opportunity to go to a user conference that includes attending the F1 Miami race in Miami which also became the theme for the conference. The Garage’s recent user conference did just that as they leveraged some of the learnings from F1 racing to illustrate how they’re racing to enable value based…