Blog
Thriving Through Transition: How Value-Based Care Can Help Healthcare Providers Navigate Medicaid Cuts and Policy Shifts
August 20, 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 Imperative […]
How We See CalAIM Impacting Maternal Health Organizations
August 20, 2025Providing equitable maternal health care is of growing interest across the nation. Disparities in access to maternal health services, including prenatal, perinatal, and postpartum care that meet the unique needs of various populations disproportionately impact Black, Indigenous, and other communities of color, leading to poor maternal health outcomes. For example, Black women are 2-3 times […]
Transforming Complex Care: Driving Outcomes and Reducing Costs with Care at Home Solutions
August 20, 2025I. Executive Summary: Care at Home Solutions is an innovative, community-based program designed by COPE Health Solutions to support high-risk, medically complex patients where they feel safest, at home. Through a physician-led, multidisciplinary care team, we aim to improve outcomes, reduce avoidable utilization, and restore connections to ongoing care. II. The Problem: Gaps in […]
Using Data to Win at MSSP
August 20, 2025“People who run ball clubs, they think in terms of buying players. Your goal shouldn’t be to buy players, your goal should be to buy wins. And in order to buy wins, you need to buy runs. You’re trying to replace Johnny Damon. The Boston Red Sox see Johnny Damon and they see a star […]
Why Most FQHC Strategic Plans Fail—and How to Build One That Delivers
July 31, 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 […]
Unleash the Power of AWVs —Transform Outcomes, Cut Costs, and Maximize Your Organization’s Financial Success
July 22, 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, […]
The End of the Convener Safety Net? Why It’s Time for Providers to Rethink Their Role in ACOs
July 22, 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 […]
Measuring Your MSO: The Key to Growth and Premium Retention
July 22, 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 […]
From Lessons to Action: CalAIM’s Impact and the Future of Medi-Cal
July 22, 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 leverage lessons learned in California for Medicaid redesign and in other states for their own Medicaid transformation and waiver efforts. Medi-Cal transformation, formerly known as California Advancing and Innovating Medi-Cal […]
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 […]