Blog

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 […]

Since the senseless murder of the UnitedHealthcare CEO, Brian Thompson, there has been a lot of discussion regarding managed care and the companies that administer services on behalf of government and private payers. The use of the inscription on the bullet casings fired from the gun that killed Mr. Thompson, “Delay, Deny, Defend” have been […]

Introduction: Medical practices are now receiving copious amounts of data that were unheard of only a few years ago. The information includes not only the results of labs and other diagnostic studies or specialist visits, but information on both cost and quality, as reflected in gaps in care as well as patient satisfaction with […]

On December 18, 2024, CMS announced that Oklahoma (statewide) and Michigan, New York, and South Carolina (sub-state regions) were accepted to participate in the Innovation in Behavioral Health (IBH) model. IBH is a new state-based model in which states are awarded $7.5 million to invest in specialty behavioral practices that serve the Medicaid and Medicare […]

Care management is best defined as a comprehensive suite of services and activities that are patient-centered to assist patients and caregivers in controlling complex and chronic conditions to better manage their own health. These programs focus on patient engagement, care coordination, and education to reduce hospitalizations, emergency department visits and improve the total cost of […]