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CMS Announces Key Updates to AHEAD: What You Need to Know

September 29, 2025

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 […]

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Federally Qualified Health Centers Leveraging Analytics to Enable Value-Based Care Success

September 29, 2025

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) […]

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Closing the Year Strong: Why Now is the Time for Health Plans to Prioritize Risk Adjustment

September 25, 2025

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 […]

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MSSP Pays Off Big in 2024—Is Your ACO Leaving Money on the Table?

September 2, 2025

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 […]

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Thriving Through Transition: How Value-Based Care Can Help Healthcare Providers Navigate Medicaid Cuts and Policy Shifts

August 20, 2025

As 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 […]

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How We See CalAIM Impacting Maternal Health Organizations

August 20, 2025

Providing 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 […]

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Transforming Complex Care: Driving Outcomes and Reducing Costs with Care at Home Solutions

August 20, 2025

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 […]

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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 […]

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Why Most FQHC Strategic Plans Fail—and How to Build One That Delivers

July 31, 2025

Strategic 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 […]

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Unleash the Power of AWVs —Transform Outcomes, Cut Costs, and Maximize Your Organization’s Financial Success

July 22, 2025

Why 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, […]

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