Blog

CMS recently announced the Long-term Enhanced ACO Design (LEAD) Model: , positioning it as the follow-up to ACO REACH, which sunsets at the end of 2026. This 10-year voluntary model kicks off January 1, 2027, and promises the longest ACO model yet. LEAD isn’t just a REACH sequel – it is breathing new life into […]

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 […]

With the release of the California Department of Health Care Services’ (DHCS) fourth and final PATH CITED funding round, $145.5 million were distributed to 153 organizations across all 58 counties in California to further support CalAIM program development. Awards were given to organizations that provide Enhanced Care Management (ECM) and Community Supports services including in-person […]

California’s CalAIM (California Advancing and Innovating Medi-Cal) initiative is approaching a pivotal milestone as its federal waiver is set to expire at the end of 2026. Launched in January 2022 under a Section 1115 demonstration waiver, CalAIM represents a major reform effort aimed at transforming how Medi-Cal serves its most vulnerable populations. Operated by the […]

Introduction: The National Committee for Quality Assurance (NCQA) Health Plan Ratings and Centers for Medicare & Medicaid Services (CMS) Star Ratings each serve as highly influential measures of health plan quality performance nationwide. These ratings serve as meaningful indicators of how well plans deliver high-quality, patient-centered care, providing consumers, employers, and policymakers with a […]

The One Big Beautiful Bill Act, signed into law earlier this summer, created the Rural Health Transformation (RHT) Program: , an initiative launched by the Centers for Medicare & Medicaid Services (CMS) to help rural communities redesign their healthcare delivery systems, expand access to quality care, develop the workforce, and improve health outcomes through innovation […]

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 […]

Federally Qualified Health Centers (FQHCs) are a crucial health care access point for underserved and uninsured communities. Yet, FQHCs face challenges with maintaining financial stability when relying solely on revenue from Prospective Payment System (PPS) rates, which tend to lag behind rising expenses. To diversify their revenue streams, FQHCs should consider pursuing Value-Based Care (VBC) […]

Introduction: For Medicare Advantage (MA) health plans and other risk-bearing organizations, accurate risk adjustment is essential to ensuring that compensation is aligned with the true health needs of your population. The accuracy of 2025 risk adjustment submissions will directly influence capitation payments and your focus on population health management. As we enter the final […]

CMS just released the 2024 results for the Medicare Shared Savings Program (MSSP)—and the message is clear: performance pays. A record-setting 75% of ACOs earned shared savings this year, the highest success rate since the program began. CMS also reinforced its commitment to MSSP as a core lever to “Make America Healthy Again,” focused on […]