CMS announced the launch of the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model, a 10-year voluntary payment model offering outcome-aligned payments (OAP) for tech-enabled management of certain major chronic conditions, in early December. For health system and digital health leaders, it stands out as both a market awareness-raising opportunity and a large-scale test of potential for OAP effectiveness—a logical follow-up to value-based payments. Fair

For so many mission and humanitarian reasons, let's all take it as a given that everyone in healthcare sees value in improving healthcare quality. And that, therefore, tools, services, resources, or process changes that improve quality will also be perceived as valuable and worth investing in. This is true enough; however, in the real world, it often happens that a more detailed quality ROI case has to be made. Both on the buyer (provider, payer) side and on the vendor (tech,

Over the past few weeks, all five national, publicly traded health plans have hosted their third set of earnings calls for the year, sharing their performance from Q3 and their outlook for the remainder of 2025. We make it a point to stay on top of these players’ performance to monitor the health insurance industry’s overall financial position and to see what the data tell us about ongoing demographic shifts, the margin outlook for providers, the real-world/cost implications

With a new federal measure set to reward hospitals for participating in the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Organization (PSO) program starting next year—and a fresh government evaluation pushing for tweaks to the program to improve its effectiveness—PSOs have quickly moved from a relatively niche quality program to a potential strategy priority. PSOs play a strategic role by offering legal protections for safety event data and positioning o

Healthcare costs are accelerating faster than anyone predicted, and employers are struggling to keep up. And our team has been having an internal debate about a scenario that seemed unlikely even just a few years ago: could employer-sponsored insurance (ESI) finally be approaching its defined contribution moment—echoing the pension-to-401(k) transition that reshaped retirement benefits a generation ago? Employers have long relied on ESI to attract and retain workers, but risi

Over the course of the past few weeks, all five of the large, publicly traded health plans have hosted their second set of earnings calls...

The push toward healthcare price transparency started in earnest nearly 15 years ago, when the ACA highlighted the need for greater...

In the last couple of months, we’ve been pulling up chairs with dozens of revenue cycle leaders to understand what’s keeping them awake...

The One Big Beautiful Bill Act (OBBBA) was signed into law by President Trump on July 4 after a narrow 218-214 vote in the House and...

CMS and the OIG recently announced intention to audit health plans and providers in a set of initiatives that could recoup several billion dollars

Over the course of the past few weeks, all of the large, publicly-traded health plans have hosted their first set of earnings calls for...

Roughly half of the U.S. population gets health coverage through some form of government-sponsored insurance. And with control of both...