On July 16, 2025, the Centers for Medicare and Medicaid Services (CMS) released a Notice of Proposed Rule Making (NPRM) for CY 2026. The proposed rule indicates that CMS wants to accelerate risk within its programs with the expectation that doing so will drive better results. However, many entities are not ready, and the current quality…
Download Slides As medical practices, we are dedicated to the health and wellness of the panels we serve. We set goals, implement actions, and assess outcomes to best meet patients’ needs. But what about our care team’s outcomes and needs? Now more than ever, with the challenges of employee retention, financial stressors, competing priorities,…
For years, value-based care has remained a central debate in the health care industry amid the ongoing push to improve outcomes while controlling costs. Traditional fee-for-service models have revealed their limitations, such as data fragmentation, misaligned incentives, regulatory complexity, technology gaps, and an overall cultural hesitancy to adopt to a new business practice. These challenges…
Download Slides CMS’ new mandatory episode-based payment model, the Transforming Episode Accountability Model (TEAM), is scheduled to begin Jan. 1, 2026, affecting reimbursement for five high-volume surgical procedures. Data is key for hospitals to prepare for TEAM and to understand how markets will be impacted throughout the nation. Key takeaways: Join our Mandatory CMS…
Download Slides Exploring how AI-driven analytics can transform care management through focus on Population Health Risk Stratification and Predictive Modeling. We will discuss how advanced data science techniques using Electronic Health Records (EHR) and claims data provides us an opportunity to perform risk stratification to help identify high-risk populations, predict adverse health events, and…
Download Slides In August, CMS introduced a new mandatory model: Transforming Episode Accountability Model (TEAM), a bundled payment initiative affecting reimbursement for five key surgical procedures. Key Takeaways:Join our webinar, Unpacking the mandatory CMS TEAM model: Overcome new rules & challenges, on Sept. 24, at 1 p.m. EST. During this one-hour session, you’ll learn:…
Download Slides This deep dive covers everything you need to know about these measures. Are you struggling to understand Medicare Advantage quality measures and meet your MSO and/or payer requirements? This webinar will cover what you need to know and offer strategies to support you on your path to success. You’ll learn how to…
In an effort to improve care quality and lower costs, the healthcare industry has been working on shifting from fee-for-service to value-based care delivery. The two models differ in the way providers are reimbursed for the care they provide by rewarding them service-by-service or based on overall quality and patient outcomes. In the following article, HealthPayerIntelligence breaks…
Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of value-based…
The nonprofit National Committee for Quality Assurance has revised quality measures for health plans in the Healthcare Effectiveness Data and Information Set (HEDIS) for measurement year 2023. NCQA has added race/ethnicity stratifications and made revisions to acknowledge and affirm member gender identity. Collecting race and ethnicity data is key to improving health disparities, NCQA said….