Blog

Introduction:: Federally Qualified Health Centers (FQHCs) serve as an essential access point for uninsured, underinsured and high-need patients, and are uniquely positioned to address both primary care and health-related social needs (HRSNs) of underserved populations. Because of their mission of serving those who may otherwise not have access to care, FQHCs historically have focused […]

As California’s CalAIM initiative and the broader healthcare landscape continue shifting toward value-based care (VBC), Enhanced Care Management (ECM) providers must prepare to be successful. ECM’s emphasis on social determinants of health, preventative care, and care coordination aligns with Managed Care Plans’ (MCPs) evolving priorities and incentives to drive improved health outcomes and lower the […]

California’s healthcare landscape is undergoing a significant transformation with the integration of Community-Based Care Management into Dual Eligible Special Needs Plans (D-SNP) under the CalAIM initiative. The shift aims to enhance care coordination for individuals eligible for both Medicare and Medi-Cal, aligning with the principles of Value-Base Care (VBC).   What is CICM?: California […]

As we approach the Medicare Shared Savings Program (MSSP) Phase 1 application period for Performance Year (PY) 2026, now is the time to take stock of how changes in the Medicare policy environment affect current and prospective Accountable Care Organizations (ACO). For a more detailed review of application timeline and strategic considerations, refer to our […]

CMS has indicated that the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model is moving forward, and the pre-implementation period is well underway in awarded states Maryland, Connecticut, Vermont, Hawaii, Rhode Island, and downstate New York. AHEAD is a voluntary total cost of care model whereby CMS encourages a state-level, multi-sector approach to […]

MCP practices should consider and begin to plan for a transition to enter the MSSP ACO program for 2026 and choose stable, long-term partners to take control over your VBP future. There are two primary ways to enter the MSSP ACO program for 2026 If you separated from an MSSP ACO in 2024, you could […]

The recent news that CVS Health is exiting the Medicare ACO space, fully withdrawing from ACO REACH and selling its MSSP business to Wellvana: , highlights the ongoing challenges faced by ACO aggregators. While these organizations often position themselves as enablers of value-based care (VBC), their long-term sustainability remains uncertain, creating potential risks for providers […]

As part of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, a transformative effort to coordinate and expand health services for the most vulnerable populations in California, the Department of Health Care Services (DHCS) is directing Medi-Cal managed care plans to establish D-SNPs by 2026. Medi-Cal programs entering the Medicare Advantage market for the first […]

In a healthcare environment that is increasingly recognizing the importance of a value-based approach to healthcare delivery, partnerships between health systems and Federally Qualified Health Centers (FQHCs) provide a tremendous opportunity for both entities to invest resources thoughtfully, efficiently, and strategically to address community health needs. For health systems that own or are participants in […]

In summer 2024, the Health Resources and Services Administration (HRSA) released a long awaited Notice of Funding Opportunity for Health Center Program New Access Point (NAP) applications allowing qualified entities to apply for Federally Qualified Health Center (FQHC) designation. It is anticipated that HRSA will award 77 grants, of up to $650,000 each, with the […]