Blog

Recently we shared key considerations for organizations considering or planning to apply to the Medicare Shared Savings Program (MSSP), a progressive risk sharing program created as part of the Affordable Care Act in 2010 that enables physician networks to take risk against a budget and share in potential savings by creating Accountable Care Organizations (ACOs). […]

CMS has recently posted the Performance Year (PY) 2026 Application Dates for the Medicare Shared Savings Program, and as we rapidly approach Q2 of 2025, the time is now to start thinking about participating in the Medicare Shared Savings Program (MSSP) program in 2026. MSSP has long offered opportunities for physician networks to advance on […]

One of the main initiatives in New York’s just under $7.5 billion 1115 Medicaid waiver amendment is the formation of 13 regionally based Social Care Networks (SCN) that will be responsible for building, maintaining and strengthening networks of Community-Based Organizations (CBO) to deliver health-related social needs (HRSN) services. The Request for Application (RFA) window to […]

Background: In September 2023, the CMS released the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. At that time, we shared with you five key initial considerations. With the recent release of Version 1.0 of CMS’ Medicare Fee-for-Service (FFS) global budget methodology our team has put together some updated considerations for health […]

Medicaid membership has grown dramatically over the past decade, even with the recent dips due to fall-off from post Public Health Emergency redetermination, however Medicaid reimbursement has not kept up with inflation. Health systems and other providers are in a very tight spot with increasing costs driven by staffing, supply chain, the need to transform […]

A year ago, we explored the first results of the Global & Professional Direct Contracting (GPDC) program¹ (renamed to ACO REACH for performance year 2023) and found four themes:  Most participants could have earned greater savings by selecting a different risk arrangement (Professional or Global); “New Entrant” REACH ACOs tended to earn larger savings than […]

Community Health Workers (CHWs), also known as Promotores, are community-based professionals who provide culturally competent, person-centered support. CHWs provide a range of services for vulnerable populations to close gaps in care and navigate resources to help members better self-manage their health and social needs. In September 2022, the Biden Administration announced it was awarding $225 […]

On January 9, 2024, CMS approved an amendment to New York’s Medicaid 1115 Waiver, allowing the state to make investments in Medicaid initiatives that expand access to primary and behavioral health, address health-related social needs (HRSN) to reduce disparities and promote health equity, and strengthen the healthcare workforce. The term of the demonstration amendment will […]

Greetings health care colleagues: Well, we’re through the Yuletide season and most folks are back from holiday travels or hibernations. It’s 2024 and an election year. What can we expect to see this year and for those of us updating strategic plans and reviewing our priority initiatives what should we be considering? 1.• Significant ongoing […]