Download Slides CMS has doubled down on its commitment to reining in specialty costs by proposing another mandatory episode-based care model: Comprehensive Care for Joint Replacement Expanded, or “CJR-X.” Like the Transforming Episodic Payment Model (TEAM), CJR-X is focused on procedural episodes of care, but its global application and pinpoint focus will drastically impact…
In our last four articles, we have focused on payment models and infrastructure to establish how ACOs can be central to Value-Based Care, even under specialty models. Now it’s time to shift our focus back to what the payment models set out to do: improve patient health and rationalize costs. We cannot lift up patient…
Addressing Structural Challenges in the Business of Benefits Through AI Innovation Employer plans, whether self-funded under the Employee Retirement Income Security Act of 1974 (ERISA) or fully funded through a commercial plan, will likely have a proactive mindset that will lead to greater coverage modeling scenarios, plan accountability, and a focus on outcomes to successfully…
AI isn’t failing because it lacks capability. It’s failing because it isn’t consistently reaching the moments where decisions are made. Healthcare isn’t struggling to adopt AI. In fact, the industry has moved quickly from early experimentation to widespread investment in tools designed to improve clinical decision-making, reduce administrative burden, and drive financial performance. Many health…
Value-based care runs on a simple bet: an organization takes financial responsibility for a population’s health and keeps the savings if it can hold costs down. The organizations making that bet, physician-led IPAs, ACOs, Medicare Advantage groups, and the health plans they contract with, all run the same kind of back office to deliver on…
Why fragmented patient data became a financial and regulatory liability, and how clinical AI closes the gap at the point of care Healthcare’s data isn’t missing. It’s everywhere. We talk about value-based care like it’s a contracting problem. Get the attribution and quality measures right, and performance follows. But the real work of winning under…
To mark the 20th anniversary of value-based care, health care innovation and value-based care (VBC) leaders reflect on how the industry has evolved—and why success over the next 20 years will depend on moving from payment reform to the infrastructure, data, and care models needed to deliver measurable outcomes. Patty Hayward, General Manager of Health…
When physicians describe the forces reshaping medicine, they increasingly point not to a new device or a breakthrough drug but to the economics underneath their work. The move from fee-for-service to value-based payment is no longer theoretical. For a growing number of specialists, it is starting to feel personal. That change in perception is worth…
During 2025, the Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS) announced seven new value-based payment models. Among these new models is the Ambulatory Specialty Model (ASM), which is specifically focused on improving efficiency in care for two chronic conditions—lower back pain and heart failure. Another new model, the Long-term Enhanced…
Despite its increasing use, artificial intelligence integration is lagging at healthcare systems and organizations across the U.S., according to a new survey from Arcadia. Fifty-two percent of respondents report that AI can fundamentally transform healthcare in correct applications, though about half (53%) of AI insights are “only partially embedded” into decision-making processes and only 14% report full…