Craig Nurnberg’s Post

In 2012, the Pioneer ACO Model became one of the first major tests of what value-based payments could look like in Medicare. The model offered an ambitious promise: if high-performing healthcare organizations were given greater flexibility and shared financial risk, they could improve care coordination, lower costs, and enhance quality for Medicare beneficiaries. In this blog, we explore the model's emphasis on shared risk, quality benchmarks, and patient attribution, and how that set the stage for more advanced models that followed. https://lnkd.in/ehj8_hvJ #ACO #AccountableCare #ValueBasedPayments #VBP #XtraGlobex #Onward

Posting our latest blog from the floor of #HCBS2025 #AdvancingStates conference. integrated care and alignment have been hot topics. ACO models can provide insights to the future of VBP and the roles #providers can develop.#AskFady #Onward

In 2022, ~4% of medical spending in the US went to primary care, a decrease since 2018. And in 2025, there were 7,901 primary care health professional shortage areas. A new Health Care Cost Institute report highlights the need for strategic primary care investment: https://lnkd.in/evh4iX3y

In the Task Force's August newsletter, CEO Theresa Dreyer shares insights from our latest policy briefs with recommendations for CMMI on: ➡️ The role of conveners in supporting independent providers  ➡️ Medicare Advantage value-based models  ➡️ Specialty engagement in value-based care Read the newsletter here: https://lnkd.in/efMah6qe 

Are more physicians participating in alternative payment models, as CMS would like? Seems that for primary care docs, trends are headed in two directions: more physicians exempt AND more in two-sided accountable care arrangements (thus fewer in the "middle" in MIPS and one-sided ACOs) One interesting point in this article: as Medicare Advantage is an increasing share of panels, fewer physicians meet the eligibility threshold (based on # of fee-for-service patients) that would require them to be in the Quality Payment Program (i.e., must choose APM or MIPS). Read more in Health Affairs from Karen Joynt Maddox Peter Lyu and their co-authors: https://lnkd.in/eZ2ndd2Y

NEW BLOG POST from NYX Health® 📊 With Medicaid cuts, new regulatory barriers, and denial rates reaching 11.8%, 2025 is reshaping how providers approach revenue cycle management. Hospitals are facing an increase in uninsured patients, higher self-pay balances, and tighter payer scrutiny. Still, RCM leaders have a unique opportunity to build resilience and safeguard access to care. Read our latest blog to see what’s ahead and how to prepare: https://lnkd.in/gm-rBbXz

Primary care plays a unique and indispensable role in our nation's health. Yet, it has been undervalued in the Medicare Physician Fee Schedule (MPFS) for decades. This new Health Affairs Forefront article does a great job of explaining why. CMS' recent 2026 MPFS proposed rule aims to take some steps towards properly valuing primary care: accounting for efficiency when valuing services and obtaining more reliable, transparent, empirical data to determine physician payment. David Muhlestein, Yuvraj Pathak, SAMIA I. https://lnkd.in/ejEMJT5q

CMS's 2026 Medicare Physician Fee Schedule Proposed Rule brings big updates for care management. Highlights: -New behavioral health add-on codes for Advanced Primary Care Management -Removal of SDOH code G0136, shifting focus to "upstream drivers" -RPM/RTM valuation changes impacting reimbursement -RHC/FQHC unbundling of BHI-related codes These changes could reshape reimbursement and workflows starting Jan 1, 2026. Check out this article to learn more. #ThoroughCare #CMSFinalRule #CareManagement

Thanks for calling attention to this JP Yonushonis 🚨 Important regulatory shifts ahead: CMS’s 2026 Proposed Rule for the Medicare Physician Fee Schedule is set to change the landscape for care management. Key changes to watch: Expanded behavioral health support with new add-on codes Social Determinants of Health code G0136 phased out, with focus moving “upstream” Reimbursement adjustments for RPM/RTM services RHC/FQHC allowed to unbundle certain behavioral health codes This isn’t just a policy tweak — it’s a signal of where care delivery and reimbursement are heading. Practices that plan now will be positioned to succeed in 2026 and beyond. The question: are your care models flexible enough to adapt without adding burden to staff? Read more here 👉 https://lnkd.in/ebWGb47H #CMSFinalRule #CareManagement #HealthcarePolicy #ValueBasedCare #MedifyHealth Full article: https://lnkd.in/ebWGb47H