The Centers for Medicare and Medicaid Services (CMS) is advancing an initiative that proposes to expand access to GLP-1s for the Medicare population: the Medicare GLP-1 Bridge short-term demonstration program. Overview of the Medicare GLP-1 Bridge demonstration program CMS introduced the Medicare GLP-1 Bridge demonstration program as a short-term initiative to expand access to GLP-1…
The pressures on long-term care facilities are coming from all directions. Demand? Aging Baby Boomers and an increase in complex medical conditions are driving the need for more beds and care. Workforce? Long-term care (LTC) facilities have been dealing with staffing shortages since before COVID-19, but the situation has not fully recovered from the pandemic….
In a fifteen-minute visit, there’s already a lot happening. I’m listening to the patient, reviewing their history, asking questions, examining them, and trying to figure out what’s actually going on under the surface: the difference between what they’re telling me and what’s happening. Then I have to decide what needs to happen next. That’s the…
The Centers for Medicare and Medicaid Services (CMS) Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a voluntary CMS Innovation Center initiative designed to improve outcomes for Medicare fee for service (FFS) beneficiaries with chronic conditions through technology-enabled care. CMS announced the initial cohort of over 150 ACCESS participants in April 2026. These participants reflect…
For nearly all acute care hospitals in the United States, a new mandatory payment model is on the horizon. The Centers for Medicare and Medicaid Services (CMS) has proposed the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, a mandatory, nationwide, episode-based payment model for lower extremity joint replacements (LEJRs) in Medicare fee-for-service (FFS). If…
V28 is no longer a transition issue. It is the live operating environment for Medicare Advantage risk adjustment in 2026. CMS completed the three-year phase-in of the 2024 CMS-HCC model for CY 2026, meaning plans and providers are now operating under the full model rather than a blended version. That makes mid-year the right moment…
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…
Despite decades of progress in oncology, ranging from molecular diagnostics to targeted therapies, cancer remains one of medicine’s most complex and costly challenges. While genomic sequencing and AI-assisted analytics have improved disease classification, biomarker identification, and the discovery of drugs that may help, most patients are still treated using standardized protocols driven by population-level data rather…
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…
The healthcare industry is at a critical inflection point and the promise of value-based care is at risk due to operational complexity and clinician burnout. AI offers a potential lifeline to streamline processes and restore focus on patient care. However, widespread adoption is stalling. Concerns around trust, transparency, and usability are slowing progress. This isn’t just…