The MSSP ACO Application is Approaching: Are You Preparing Accordingly?
The Medicare Shared Savings Program (MSSP) is 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. Within the program, physicians create Accountable Care Organizations (ACOs) to cover a Medicare Fee for Service (FFS) population […]
Preparing for OBBA (H.R. 1): How Medi-Cal Plans Can Reduce Attrition and Protect Member Coverage Under New Eligibility Rules
The One Big Beautiful Bill Act (OBBA) introduces the most significant transformation of Medicaid eligibility since the Affordable Care Act (ACA), placing ACA Expansion Adults at higher risk of coverage loss and exposing large Medi-Cal health plans to $40 to $50 million in annual capitation risk.
Preparing for OBBA (H.R. 1): How Medi-Cal Plans Can Reduce Attrition and Protect Member Coverage Under New Eligibility Rules
The One Big Beautiful Bill Act (OBBA) introduces the most significant transformation of Medicaid eligibility since the Affordable Care Act (ACA), placing ACA Expansion Adults at higher risk of coverage loss and exposing large Medi-Cal health plans to $40 to $50 million in annual capitation risk. Beginning December 31, 2026, states must implement six-month redeterminations […]
5 Things to Know About California’s Medicaid Waiver Renewal
Understand what California’s CalAIM waiver renewal means for plans and providers, and the strategic moves to protect performance and funding.
A 5-Step Framework to Improve Your Health Plan’s Star Rating
Get a practical roadmap to diagnose performance gaps, prioritize HEDIS and Star measures, and focus investments where they will move scores the most.
$50B Rural Health Transformation Opportunity: What FQHCs and Rural Providers Need to Know
Learn how the Rural Health Transformation program can fund long-term stability, workforce, and innovation for FQHCs and rural providers.
CMS Announces Key Updates to AHEAD: What You Need to Know
The Centers for Medicare & Medicaid Services (CMS) recently announced updates to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model, a state total cost of care model that Maryland, Connecticut, Hawaii, Vermont, Rhode Island and Downstate New York will participate in. While certain changes affect state requirements, key changes affecting hospitals and providers include: […]
Measuring Your MSO: The Key to Growth and Premium Retention
As 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 […]
Actions to Take Now for Awarded MCP Practice Participants
1. Evaluate your practice’s capacity to meet the three domains of MCP’s care delivery approach*: care management, care integration, and community connection * Practices must meet the care delivery requirements in their starting Track by the end of PY2 (12/31/25) 2. Evaluate financial implications to your practice by modeling the six new MCP payment types; […]
5 Things to Know About CMS First AHEAD Awards
On July 2, CMS announced the first states to be accepted to participate into the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model. The states that were announced as participants are Vermont, Maryland, and Connecticut. In addition, Hawaii has also been conditionally accepted pending satisfaction of certain requirements. If you are located in a state that […]