As the Centers for Medicare & Medicaid Services moves forward with the Transforming Episode Accountability Model (TEAM), hospitals are taking on financial accountability for Medicare’s most complex and costly surgical episodes. Hospitals that don’t take action to achieve better patient outcomes could find themselves owing Medicare money.
While TEAM shifts meaningful risk to hospitals, it also creates an opportunity often missing in value-based care: true collaboration with
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
4 out of 5 Rural Texans Face a “Life-Threatening” Chronic Disease Crisis, PCCI Data Shows
What You Should Know
The Finding: An analysis using the Parkland Center for Clinical Innovation’s (PCCI) Community Vulnerability Compass (CVC) reveals that four out of five rural Texans live in communities highly vulnerable to life-threatening chronic diseases.The Distinction: Rural vulnerability is structurally different from urban vulnerability. While urban challenges are often driven by environmental exposures and behavioral risks, rural vulnerability is deeply tied to entrenched clinical
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TrumpRx.gov Launches with 80% Discounts on Ozempic and Wegovy
What You Should Know
The Launch: President Trump has officially launched TrumpRx.gov, a consumer-facing digital portal that allows patients to access "Most-Favored-Nation" (MFN) pricing on high-cost drugs. The initial rollout features deals with five major manufacturers: AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer.The Prices: The platform delivers massive price cuts on blockbuster GLP-1 weight loss and diabetes drugs. Ozempic and Wegovy will drop from over $1,000/month to as
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The ‘Volume’ Era is Dead: Humana Data Proves Value-Based Care Cuts Admissions by 24%
What You Should Know
The Report: Humana’s newly released Value-Based Care By the Numbers Report, reveals that Medicare Advantage members in value-based care (VBC) arrangements are seeing significantly better outcomes than those in traditional models.The Data: The impact is measurable and massive: VBC patients experienced 24.3% fewer hospital admissions and 13.4% fewer emergency room visits in 2024.The Shift: The report validates the industry's transition from "reactive" fee-for-service
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Price Reset 2026: How Trump’s ‘Great Healthcare Plan’ Slashes Drug Costs at Trumprx.gov
What You Should Know
- Today, President Donald J. Trump has launched "The Great Healthcare Plan," a sweeping initiative designed to lower prescription drug costs to the lowest international levels and reduce insurance premiums by over 10%.
- The “Great Healthcare Plan” shifts taxpayer-funded subsidies away from "big insurance companies" to be delivered directly to the American people, while mandating unprecedented "Plain-English" transparency standards for every insurer and provider
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AMA’s Strategic Push for Permanent Medicare Telehealth Reform
What You Should Know
- The AMA is urging Congress to pass permanent authorization of Medicare telehealth services before the current waiver expires on January 30, 2026.
- This advocacy follows a "tumultuous" 2025 in which a 43-day government shutdown caused a 24% national drop in fee-for-service telemedicine visits, demonstrating the extreme sensitivity of patient access to legislative lapses.
The Economic Battle: Challenging CBO Scoring
The crux of the AMA’s issue brief is a
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Avoiding the Telemedicine Cliff: Why the DEA Extended Prescribing Rules Through 2026
What You Should Know:
- In a significant move for the "tele-prescribing" landscape, the U.S. Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) have announced a fourth temporary extension of telemedicine flexibilities.
- This extension allows practitioners to prescribe controlled medications—including Schedule II–V drugs—via audio-video encounters without a prior in-person medical evaluation through December 31, 2026.
A Transitional
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The MAHA Paradox: How Medical Device Tariffs Undermine “Make America Healthy Again
The Trump Administration’s Make America Healthy Again agenda recognizes a simple truth: the best way to improve our health is to empower people to understand and help manage their own care. Affordable medical devices make that possible.
Every day, Americans use this technology to check their blood pressure, track sleep, monitor heart rhythms, manage hearing loss, and more. These devices bring care into our homes, extend the reach of doctors, and help millions of people stay healthy
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CMS Launches $50B in Awards to Strengthen Rural Health in All 50 States
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) is deploying a massive $50 billion investment across all 50 states to overhaul the nation's rural healthcare infrastructure starting in 2026.
- Under the guidance of HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz, the program prioritizes not just workforce expansion, but a significant technological shift toward AI adoption, cybersecurity resilience, and "food-as-medicine"
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CMS Launches WISeR Model: New Medicare Prior Authorization Rules Start Jan. 1
Earlier this year the Centers for Medicare and Medicaid Services introduced the "Wasteful and Inappropriate Service Reduction" model, a series of prior authorization requirements designed to ensure timely and appropriate Medicare payment for select items and services in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) that take effect Jan. 1.
As part of the “WISeR” requirements, CMS selected tech vendors to implement enhanced technological models to
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