Submitting data to CMS is one of those tasks that sounds straightforward until you realize how many moving parts are involved. A missed measure, an incomplete record, or a data entry mistake can drag down your MIPS score and leave money on the table. The good news is that a solid internal audit can catch…
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…
With the government shutdown thankfully behind us, health systems can get back to business with some of the innovative programs that are producing great outcomes and satisfying patients. A growing number of Americans are receiving hospital-level care without leaving their living room, thanks to advanced technology and an evolving healthcare landscape that is delivering much…
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,…
Across hospitals and health systems, COOs remain focused on improving patient access. As many organizations face growing demand and a need for additional capacity, they are implementing various strategies, including expanding their ambulatory networks and launching telehealth programs. How have their efforts to track access — such as new dashboards and top operational key performance indicators— evolved in 2025?…
CMS has clarified that only select Medicare claims will be held amid the ongoing federal government shutdown, walking back an earlier notice that suggested a broader payment pause. “In light of the continuing government shutdown, CMS will continue to process and pay held claims in a timely manner with the exception of select claims for…
On Jan. 1, CMS will begin implementation of a new alternative payment system for select hospitals. The Transforming Episode Accountability Model will hold participating hospitals responsible for the care quality, costs and post-acute coordination associated with five surgical procedures. The model is intended to mark a shift toward shared accountability and a test of whether healthcare providers…