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

March 9, 2026Garrett SchmittNo Commentsvalue-based care, vbc

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

March 6, 2026Garrett 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?

March 6, 2026Garrett 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

March 5, 2026Garrett 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…

Value-Based Care Emerges as a Strategic Anchor in an Uncertain Regulatory Climate

March 4, 2026Garrett Schmitt

Behavioral health has entered a new era of accountability. Proof, measurements and improved outcomes are taking on renewed importance during a year that many anticipate will bring heightened scrutiny and uncertainty in the regulatory environment. But a focused pivot from growth to proof does not mean that 2026 will be a year of slowed or…

Around the nation: Optum launches new AI tool for value-based care

March 3, 2026Garrett SchmittNo CommentsApple, community health, creativity, digital health, health care, health disparities, health inequity, healthcare, healthcare innovation, Jefferson Health, SPAC, Steve Jobs, Steve Klasko, structural health disparities

Optum* is launching a new artificial intelligence (AI)-powered tool for value-based care (VBC) called Value Connect, in today’s bite-sized hospital and health industry news from California, Minnesota, and Texas.    Full Article

Podcast: Is Value-Based Payment Failing U.S. Healthcare?

February 27, 2026Garrett Schmitt

Health Affairs’ Jeff Byers welcomes Brown University’s Andrew Ryan to the pod to discuss his recent Forefront article that explores whether value-based payment and managed care can lead to addressing the core drivers of spending. Full Article

Medicare Alternative Payment Models That Support Improved Primary Care

February 26, 2026Garrett Schmitt

Primary care is critical for population health, health equity, and the overall efficiency of the health care system.1 It also has been consistently associated with improved life expectancy and reduced health care disparities. The four defining features of high-functioning primary care are: accessibility comprehensive care for most patient problems continuity of care over time coordination of…

RECORDED WEBINAR: The Missing Layer in Value-Based Care: Turning Performance into Financial Truth

February 26, 2026Garrett SchmittNo CommentsACOs, vbc, Webinar

 Download Slides Many healthcare organizations can see performance—but far fewer can translate that performance into financial truth. As providers, ACOs, payers, and community health centers move deeper into value-based care, the gap between analytics and contract reality becomes a critical risk. In this session, Syntax—a division of Lightbeam Health Solutions—introduces the missing layer in…

The Changing Face of Long-Term Care

February 26, 2026Garrett SchmittCoding, HCC, MVPs, Risk adjustment coding

February 26, 2026 – Long-term care is becoming a care concept rather than a care setting. It’s another node in the care ecosystem where medication intelligence is the connective tissue and a critical success factor for home-based care. If you mention long-term care (LTC), most people think of nursing homes – brick and mortar facilities where…

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