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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 […]

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 […]