What You Should Know:
- A new report from Sage Growth Partners reveals a striking disconnect in the healthcare industry: while only 20% of C-suite leaders believe progress has been made in value-based care (VBC) recently, 77% plan to increase their participation in these models over the next two years.
- The "plot twist" indicates that despite operational hurdles and low revenue exposure today, hospital executives view VBC as essential for long-term financial survival. The data
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
The $4,000 Deductible Era: Why Employer-Sponsored Insurance is Breaking the American Worker
What You Should Know:
- A new 50-state analysis reveals that over half (51.7%) of U.S. private-sector workers are now enrolled in high-deductible health plans (HDHPs) as employers struggle to manage rising costs. The report shows that annual family premiums jumped to $24,540 in 2024, outpacing inflation, while average family deductibles surpassed $4,000 for the first time.
- The trend exposes millions of Americans to greater financial risk in medical emergencies, signaling a
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Beyond Stereotypes: 3 Ways Empathetic Outreach Can Drive Medicaid Member Engagement and Retention Post-OBBA
Connecting with Medicaid members has never been so challenging—or so crucial—as the system faces great uncertainty in light of the recently passed One Big Beautiful Bill Act.
Finding inroads that resonate with members can be difficult as this diverse segment faces plenty of barriers to care that also inhibit meaningful connections. Non-medical social drivers of health, such as lack of transportation, food and housing insecurities, and even basic health literacy can get in the way of
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ACOs Must Lead on Specialty Care to Control Costs
Both the greatest strength and weakness of the ACO shared savings (MSSP) model is its focus on primary care, particularly chronic disease. ACOs have put patients with diabetes, hypertension, and other conditions usually handled through primary care physicians at the center of care coordination, population health, and care management. But as CMS Value-Based Care’s central goal has shifted to cost control, ACOs will need to broaden scope to optimize specialty care. TEAM (Transforming Episode
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CMS Notifies 742 Hospitals of Pricing Targets for New Value-Based Payment Model
What You Should Know:
- On November 15, 2025, the Centers for Medicare and Medicaid Services (CMS) will begin notifying 742 hospitals and health systems of their 2026 pricing targets and quality scores for the Transforming Episode Accountability Model (TEAM).
- CMS issued a final rule in July codifying the TEAM model, which aims to reduce costs and improve the quality of outcomes for millions of Americans.
TEAM Model
The model focuses on the five highest-spend surgical
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Reinventing Value-Based Care Program Administration with AI
Implementing a new VBC program in healthcare requires cross-functional support and overcoming numerous challenges. Simplification opportunities exist to address pain points for program administrators such as rigorous research, ROI assessment, and stakeholder engagement. Manual processes, including participant recruitment, financial modeling, program integrity management, and technical assistance can benefit from technology to streamline and automate tasks, allowing skilled resources to focus on
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Demystifying Prepay Coordination of Benefits: A Crucial Component of Payment Integrity
Coordination of benefits (COB) is a key component of any effective payment integrity program. But determining primacy for members with multiple plans and ensuring claims aren’t overpaid can be a complicated process. Whether it’s verifying employment status or sifting through complicated claims, COB takes significant time for peak accuracy. And while health plans focus on the intricacies of an effective COB strategy, many overlook the possibilities that a comprehensive prepay COB solution can
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Reimbursement Shift under 2026 PFS Poised to Usher in New Era for RPM
The annual release of the Medicare Physician Fee Schedule (PFS) generated more attention than usual this year among practices that have considered or are already offering Remote Patient Monitoring (RPM) to their patients. CMS’s July 14 publication of the proposed rule, outlining revisions to payment policies and rates, was seen as particularly significant for RPM.
Key changes to RPM under the 2026 PFS include the introduction of a code for 2-15 days of data collection and another that allows
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Why Value-Based Care Fails to Reward LTPAC Providers Today
The chorus of voices singing the praises of value-based care is growing ever louder. But in LTPAC, it still feels like the system’s asking providers to do more—with less—and faster than ever.
For the past 25 years, financial strategy in long-term and post-acute care has been tied to two things: occupancy and payer mix. Around 70% of residents are covered by Medicaid. The rest—split between Medicare fee-for-service, Medicare Advantage, and private pay—bring in higher rates, especially
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How Online Resources Can Help Find the Ideal Therapist
Reaching out to a therapist is the first step to start the healing you deserve. Finding the right person for your journey can require more help than a typical Google search. If you’re ready to find a licensed mental health professional who can guide your growth, learn how to find a therapist with an online resource that makes the process easy.
Why Finding the Right Therapist Is Crucial
If you look up a therapist in your hometown, you may find several options. Although they could all have
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