Blog
Thriving Through Transition: How Value-Based Care Can Help Healthcare Providers Navigate Medicaid Cuts and Policy Shifts
August 13, 2025As federal policy evolves, healthcare providers serving Medicaid populations are bracing for intensified financial strain. H.R. 1 will impact Medicaid eligibility and financing, with an expected increase in the uninsured population and decrease in federal health care spending. These changes will place immense pressure on providers to maintain care quality with diminished resources. The […]
Why Most FQHC Strategic Plans Fail—and How to Build One That Delivers
July 30, 2025Strategic planning has always been a requirement for Federally Qualified Health Centers (FQHCs). In today’s rapidly evolving market, the right strategic plan—centered on value-based payment (VBP) and value-based care—is also a competitive differentiator. CMS is accelerating the shift to VBP, and managed care plans are becoming more selective with their partnerships. FQHCs that treat strategic […]
Prior Authorization Change for Traditional Medicare
July 17, 2025What Happened?: In early July, CMS announced that they will be launching a new technology focused prior authorization process in six states to help combat fraud, waste and abuse in Traditional Medicare. CMS has highlighted that fraudulent or abusive billing practices, the provision of services with minimal clinical benefit and the use of riskier […]
Unleash the Power of AWVs —Transform Outcomes, Cut Costs, and Maximize Your Organization’s Financial Success
July 8, 2025Why Annual Wellness Visits (AWVs) still matter. Organizations need to start with AWVs to drive better care, lower spend, and maximize revenue performance. The Annual Wellness Visit (AWV) remains one of the most underused yet strategically essential tools in a health plan’s arsenal. AWVs directly impact risk scores, identify patients who need complex care management, […]
From Lessons to Action: CalAIM’s Impact and the Future of Medi-Cal
July 8, 2025Medi-Cal Transformation is evolving, and the lessons learned since its launch in 2022 have created significant discussion throughout California and other states regarding opportunities to push Medicaid and state waiver programs forward with the evolving healthcare landscape. Medi-Cal Transformation, formerly known as California Advancing and Innovating Medi-Cal (CalAIM), is reshaping the state’s Medicaid system to […]
Measuring Your MSO: The Key to Growth and Premium Retention
July 8, 2025As healthcare organizations navigate a rapidly evolving landscape shaped by value-based care, population health, and payer-provider realignment, many providers are turning to Management Services Organizations (MSOs) to enhance operational efficiency and fuel growth. Whether you’re an independent practice, a medical group, or an emerging provider network, evaluating the size and scope of your MSO is […]
The End of the Convener Safety Net? Why It’s Time for Providers to Rethink Their Role in ACOs
July 8, 2025If you’re in a convener-led ACO and think downside risk isn’t your problem, that may be about to change. CMMI is signaling a move toward requiring providers themselves to assume part of the financial risk even if they are participating in an ACO through a convener. This shift would dramatically reshape long-standing assumptions about Medicare […]
Centering Value-Based Care in your Federally Qualified Health Center Strategic Refresh
July 8, 2025Why is strategic planning key to FQHC success in our current health care landscape?: Strategic planning has long been a cornerstone of success for Federally Qualified Health Centers (FQHCs) and a mandate of the Centers for Medicare and Medicaid Services (CMS). At its core, a strategic plan provides a structured framework for evaluating the […]
Navigating Medi-Cal Changes: Strategic Considerations for Health Plans, Providers, and Community Partners
June 10, 2025California’s Medi-Cal program is facing a period of fiscal tightening that we have not seen since the enactment of the Affordable Care Act back in 2010. Driven by both state-level budget constraints and federal policy proposals, cuts will be real and painful. With the Medi-Cal program’s costs projected to exceed $194 billion by FY 2025-26, […]
Sustaining Care Quality Amid Budget Pressures: Strategic Cost Management for IPAs, CINs or RKKs in Navigating Medicaid Cuts
June 10, 2025• With reductions in healthcare funding on the horizon, especially in Medicaid, proactive planning is essential to optimize the use of limited care dollars. • Reengineering care delivery and transforming practices are not optional but necessary steps to safeguard care access and quality under tightening budget conditions. • Data analytics will provide a critical foundation […]