CMS Administrator Dr. Mehmet Oz said that Medicaid’s rapid spending growth is unsustainable and criticized state financing tactics that let providers and governments “game” the system for extra federal funds. He said CMS is shifting its fraud strategy to follow the flow of money rather than just individual offenders in an effort to ensure health dollars are used for legitimate care.
Experts believe value-based care won’t ever reach scale unless fundamental barriers are addressed — including voluntary models, misaligned payer incentives, excessive metrics and weak employer engagement.
How can AI benefit and improve patient outcome in the emergency department? Watch the latest episode to find out.
As an industry, we need to ask hard questions. Are delegated vendors delivering on the promise of better, faster, more transparent decisions? Or are they simply moving the pain to another part of the system?
Healthcare groups are pushing back on CMS’ proposed physician fee schedule for next year, raising concerns over payment cuts, administrative burdens and mandatory participation in a new value-based model. Organizations including MGMA, NAACOS and Premier are calling on the agency to revise its plan.
Out of the 476 ACOs that participated in the Medicare Shared Savings Program in 2024, 75% earned $4.1 billion in performance payments, CMS reported.
This proposal reflects a broader shift toward more restrictive oversight of inpatient utilization. As CMS finalizes this policy, providers should be aware of the immediate compliance and reimbursement risks associated with the phase-out.
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
Health care in the United States is confusing for patients and consumers. Price transparency is a step in the right direction — transformative change can happen by combining cost, quality, appropriateness and efficiency measures.
A combined bottom-up facility-level approach to integrated data and a top-down national-level effort for connected networks is needed to eliminate data silos and deliver frictionless care.
Outcomes are no longer a nice-to-have or a post-hoc justification for care provided. They are a central currency of care in a system that’s shifting faster than ever toward accountability.
CMS launched a new initiative to promote better data interoperability and digital health innovation. As part of the effort, more than 60 organizations pledged to build patient-facing apps and support secure data sharing — including OpenAI, Amazon, Apple, Cleveland Clinic and Providence.
Greenway Health blends smart technology with human expertise to elevate revenue cycle.
High-performing groups treat utilization with the same rigor they apply to coding and quality. Here are four key principles we’ve seen successful organizations adopt.
CMS proposed a 2.4% Medicare payment increase for hospitals’ outpatient departments and ambulatory surgery centers in 2026, along with a new two-tiered physician reimbursement structure based on participation in value-based care models. Provider groups are welcoming the short-term boosts, but they fear the changes don’t go far enough to address their long-term financial pressures.
At the heart of this fight are the patients whose lives quite literally depend on Medicaid. But we are also fighting for the caregivers who show up every day, the children who rely on stability, the families who rally around their loved ones, and all those whose lives are shaped by access to care.
A group of Democratic attorneys general filed a lawsuit against HHS and CMS, arguing that their recent final rule will harm access to care under the Affordable Care Act.
Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.