The Next 340B Risk Is Operational Blindness
Since 2020, HRSA has posted hundreds of manufacturer notices affecting covered entities, while litigation involving contract-pharmacy restrictions and state protections continues to reshape the program. For community health centers, the risk is not simply that 340B is changing. It is that these changes can affect cash flow, financial performance, compliance, and patient services before leadership […]
5 Strategies to Enhance FQHC Performance and Financial Sustainability
Federally Qualified Health Centers (FQHCs) play a critical and innovative role in delivering comprehensive care to underserved communities, yet they face ongoing challenges in sustaining financial health and operational efficiency. With Medicaid and Medicare margins tightening as rate increases lag behind inflation, and reductions in Medicaid and ACA marketplace membership driving growth in uninsured, proactive […]
Protecting Medicaid Coverage in a New Era of Eligibility Requirements
Across the country, Medicaid health plans are preparing for one of the most significant operational shifts since the end of the COVID-19 pandemic. New federal Medicaid eligibility and redetermination requirements established under H.R. 1 will require organizations to rethink how they engage members throughout the renewal process. And we’re only five months out. States have […]
Health Centers Can’t Grant Their Way to Revenue Stability — Medicare Is the Better Path
Community health centers face mounting financial pressure from rising costs, workforce shortages, Medicaid enrollment shifts, and federal funding uncertainty. While historically not a focus of health centers, Medicare is also becoming a larger share of the payor mix. In 2024, adults age 65+ were already the fastest-growing health center population, Medicare beneficiaries exceeded 11% of […]
Significant Changes Ahead: CMS Doubles Down on Value-Based Care In Proposed 2027 Medicare Rule
The Centers for Medicare & Medicaid Services (CMS) has released its proposed 2027 Medicare Physician Fee Schedule (PFS) and Quality Payment Program rule, signaling one of the most significant Medicare policy updates in recent years. While the proposal continues to put pressure on traditional physician reimbursement, it also reinforces CMS’s long-term commitment to expanding accountable […]
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.