You cannot control CMS raising cut points. But you can control how you respond. Changes are happening to how Medicare Advantage plans are measured for medication adherence. Starting in measurement year 2026, CMS is introducing sociodemographic status (SDS) risk adjustment into the three Part D adherence measures: diabetes medications, RAS antagonists, and statins. What’s Actually…
Enhanced ACA premium tax credits expire Dec. 31, leaving millions of marketplace enrollees facing higher premiums in 2026. Congressional efforts to extend the subsidies have stalled, with neither a Democratic three-year extension proposal nor a Republican alternative focused on HSAs passing the Senate. A House vote on extending the subsidies could still happen in early…
The 2026 Medicare Physician Fee Schedule Final Rule is Here The 2026 Medicare Physician Fee Schedule (MPFS) Final Rule is out and you’re wondering what it means for you. It’s packed with finalized updates on MIPS, six new MVPs, easier ACO reporting, a new program model, and acknowledgment of the extensive feedback received on multiple…
You cannot control CMS raising cut points. But you can control how you respond. The 2026 requirements are clear. CMS is implementing risk-adjusted measures focused on Social Determinants of Health. The new Excellent Health Outcomes for All reward ties STAR ratings exclusively to performance among your hardest-to-engage members—Dual-Eligible, Low-Income Subsidy, and disabled populations. These changes…
For all the progress made in shifting the U.S. healthcare system toward value-based care, one of the most powerful levers for improving outcomes and reducing costs remains underused: medications. Medications influence every dimension of health outcomes. They prevent disease progression, reduce hospitalizations, and determine whether chronic conditions stay controlled or spiral into costly complications. Yet,…
The transition to value-based care may seem daunting for many healthcare leaders, especially those who operate independently and have less margin for error when it comes to implementing new systems and initiatives. Flagler Health is a technology company offering AI tools and other advanced technologies to streamline many aspects of patient care for medical practices….
Download Slides Are you prepared for heightened scrutiny from the Centers for Medicare & Medicaid Services (CMS)? CMS is dramatically amplifying its audit efforts, with a renewed focus on Medicare Advantage plans and Risk Adjustment Data Validation (RADV) audits. This is not just another day at the office—CMS is expanding its audit workforce, increasing…
Electronic Clinical Quality Measures (eCQMs) are revolutionizing the way healthcare organizations evaluate care quality, track patient outcomes, and meet regulatory requirements. By embracing digital solutions, providers can not only streamline reporting processes but also deliver higher-quality care tailored to individual needs. This blog combines practical steps for eCQM implementation with the latest trends shaping their…
As the healthcare industry continues its shift toward value-based payment models, ASCs could be poised to be major beneficiaries of this transformation. Many industry leaders believe ASCs’ cost efficiency, streamlined operations and focus on quality outcomes make them ideal candidates for success in a value-driven healthcare landscape. According to FTI Consulting’s “Hospital Operations Outlook Survey,”…
In the complex world of healthcare, the importance of accurate coding and billing cannot be overstated. For healthcare providers participating in Medicare Risk Adjustment (MRA) programs, coding compliance is crucial in ensuring that patients receive the right care and that healthcare organizations meet legal and financial obligations. Non-compliance can lead to significant financial risks, regulatory…