As the healthcare affordability crisis escalates, efforts to fix the U.S. health system seem to have hit a wall. Some policy experts are calling for government price controls, while other experts and healthcare leaders still support value-based care (VBC), despite its limited impact on national health spending. Can these two schools of thought be reconciled…
On March 31st, 2026, CMS released details on a new model called LEAD — the Long-term Enhanced ACO Design. It’s positioned as a replacement for ACO REACH. However, LEAD is not just an evolution of ACO REACH. It’s a fundamentally different proposition: a ten-year model with a fixed benchmark that never rebases, an integrated approach to…
Dermatology is moving toward outcome-based measurement, but the systems to capture patient outcomes (especially through EHRs or mobile tools) are still difficult and costly to implement, according to Marta J. Van Beek, M.D., M.P.H., a dermatologic surgeon at University of Iowa Health Care and a clinical professor at the university’s Carver College of Medicine. She…
Value-based care has largely won the policy debate in American healthcare. Across Medicare, Medicaid, Medicare Advantage, and commercial insurance, payment models increasingly tie reimbursement to quality, outcomes, and total cost of care rather than volume of services. Participation in alternative payment models is no longer experimental or optional for many organizations, as it’s often embedded…
Download Slides ACOs are only recently beginning to aggregate their patient data. Required to adopt data aggregation by new APP Reporting requirements, many now understand some of the difficulty with multiple EHRs. ACOs are now all too aware of the lack of practice staff capable of queuing up data or resolving data issues, and…
Download Slides If you’re a TEAM participant, you know the responsibility that comes with it: managing the cost of care and driving care delivery innovation across 30-day episodes for five surgical procedures. Yet many hospitals are struggling with one of the most complex — and often misunderstood — components of the model: target price…
In December 2025, the Centers for Medicare and Medicaid Services (CMS) announced the Long-term Enhanced ACO Design (LEAD) Model. Set to run from 2027 to 2036, the longest time horizon that CMS has tested to date, LEAD introduces several features to encourage coherent trajectories of care, including population-based payments, more predictable benchmarking, and episode-based risk arrangements to…
Provider health systems and hospitals are under growing pressure to assume greater financial accountability for the total cost of care. Federal and state payers and some commercial health plans are accelerating the move from fee-for-service (FFS) payments to value-based care (VBC) models, including high-risk hospital global budget models. Hospital global budget methodologies establish fixed annual…
As value-based care continues to reshape the health insurance landscape, health plans face mounting pressure to evolve by continuing to become a true partner in care delivery. The shift demands more than operational adjustment — it requires a fundamental rethinking of how plans engage with providers, share data and measure success. To understand how health…
By Archana Gupta Dementia Is No Longer Peripheral to Value-Based Strategy Within most ACO populations, dementia quietly represents one of the most operationally complex and financially consequential cohorts. It is rarely the largest by diagnosis count, yet it disproportionately influences total cost of care, emergency department utilization, inpatient admissions, post-acute transitions, and long-term institutional…