Navigating the Fog: How Health Plans Can Succeed Through Policy and Market Shifts
Healthcare organizations are in a period of accelerated transformation. Evolving Medicare Advantage policies, mounting Medicaid funding pressures, pharmacy closures, and increased regulatory scrutiny are converging to create a more complex and challenging operating environment. At the same time, this disruption is creating significant opportunities for transformation. As financial and operational pressures intensify, organizations are reevaluating […]
FIVE THINGS TO KNOW: New York’s Rural Community Health Integration (RCHI) Funding Opportunity
New York State has launched a landmark funding initiative under its Rural Health Transformation Program (RHTP), backed by a $212 million federal CMS award. The Rural Community Health Integration (RCHI) initiative, the first of four program tracks, is designed to catalyze coordinated rural health partnerships across 48 eligible counties in New York State. For health […]
Transforming Complex Care: Driving Outcomes and Reducing Costs with Care at Home Solutions
I. 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 Post-Acute […]
6 Things to Know About CMS’ Recent ACO REACH Model Updates
The Center for Medicare and Medicaid Services (CMS) recently issued a notice announcing changes to the ACO REACH for Performance Year 2026. The ACO REACH currently is projected to conclude at the end of 2026, but there is ongoing speculation around a potential expansion. CMS’ intent of these changes is to improve model sustainability by […]
Policy Pulse Check: What Key Medicare Updates So Far in 2025 Mean for ACOs
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 […]
Considerations for Hospitals and Providers Amidst CMS Released AHEAD V3.0 Financial Model
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 care that […]
Key Considerations for Hospitals and Providers Amidst CMS Announcement of Cohort 3 AHEAD Awards
On October 28, CMS announced that Rhode Island and Downstate New York were accepted to participate into Cohort 3 of the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. Cohort 3’s first Performance Year is 2027. Downstate NY will consist of the following five counties: Bronx, Kings, Queens, Richmond, and Westchester. AHEAD is a […]
The Importance of Credentialing Processes in Healthcare Practices
The National Committee for Quality Assurance was founded in 1990. For almost four decades, practices have been required to maintain, and regularly submit to carriers, credentialing data for their clinicians. So how is it, nearly forty years later, practices still treat this process as an afterthought? The reality of “the re-cred firedrill” is not limited […]
5 Things to Know About ACO REACH Health Equity Data Reporting Submissions
On October 3rd, 2023, CMS published an ACO REACH Newsletter providing PY23 HEDR submission procedure and timeframe updates. Health Equity advancement is a fundamental component of the ACO REACH model and a key differentiator from its predecessor, the Global and Professional Direct Contracting Model (GPDC). CMS established HEDR requirements for REACH ACOs as part of […]
5 Things to Know about Medicaid Redetermination
As of August 2022, preliminary federal estimates showed that Medicaid enrollment stood at more than 90.9 million people, or more than one in four Americans, following the impact of the Families First Coronavirus Response ACT, which enabled continuous enrollment for Medicaid beneficiaries through the COVID-19 pandemic. Information beneficiaries should know: CHS has deep expertise in redetermination […]