Medicare VBC vs MA: A Debate on Value-Based Care

The Medicare Shared Savings Program (MSSP) achieved its most successful year yet—delivering $6.5 billion in total savings in 2024, a 25% increase from 2023. Of this, $4.1 billion went to accountable care organizations (ACOs), with $2.4 billion returning to Medicare. Beyond financial success, ACOs also saw improvements in key quality metrics—including blood pressure, diabetes, and depression management—highlighting the continued strength of physician-led, primary care–driven models in advancing value-based care. As regulatory changes encourage broader participation, these results reaffirm the importance of collaboration, innovation, and strong primary care networks in shaping the future of integrated healthcare. 👉 Read the full article to explore how MSSP’s record performance reflects the next phase of accountable care growth and policy reform: https://lnkd.in/ecq-DmjR #ValueBasedCare #ACOs #IntegratedCare #PopulationHealth #HealthcareLeadership #Medicare #MSSP #PrimaryCare #IHE #IntegratedHealthcareExecutive

New! LDI Fellow Eric Roberts and Renuka Tipirneni found smaller Black-white disparities in some preventive care use under Medicare Advantage compared to traditional Medicare, and Latinx beneficiaries used less preventive care than white beneficiaries in both Medicare programs. Read more here: https://lnkd.in/dt89MZyx CC: Institute for Healthcare Policy and Innovation, University of Pennsylvania Perelman School of Medicine

As the Centers for Medicare & Medicaid Services (CMS) updates its risk-adjustment model, clinicians may soon see relief from administrative strain tied to diagnosis coding. The new Version 28 aims to reduce overpayment risks and improve equity across Medicare Advantage and traditional Medicare—though it may also challenge early disease detection efforts. Looking ahead, CMS plans to leverage interoperable electronic health data to refine payment accuracy, cut documentation burdens, and enhance value-based care delivery. Learn how these reforms could reshape reimbursement, physician workflows, and patient outcomes in the full article: https://lnkd.in/eW9W-3Va #Medicare #CMS #ValueBasedCare #HealthPolicy #RiskAdjustment #Interoperability #HealthEquity #HealthcareInnovation #FRMC #FirstReportManagedCare

Compliance isn’t optional for healthcare facilities. Facilities must comply with requirement from The Centers for Medicare & Medicaid Services (CMS), The Joint Commission, and ASHRAE. Read the details on our breakdown. https://lnkd.in/gnu3qNZB

The 2025 Health Reform Act (HR1) is placing new financial pressure on hospitals — reducing Medicaid, DSH, and 340B access — and forcing organizations to rethink their long-term strategies. This article explores how physician leaders can adapt through strategic service redesign, payer realignment, and operational innovation to sustain care delivery in a changing landscape. Read more 👇 https://hubs.la/Q03R6pSj0 #PhysicianLeaders #HealthcareLeadership #HealthPolicy #HospitalManagement #HealthcareStrategy

Tue, Oct 21st. 1st week of Medicare AEP is almost under our belt, WATCH this video for next steps. This week I am briefly discussing Medigap-Supplement vs Advantage plan pros and cons. Lets talk! #yourhealthyourmoneyaz #medsuppvsadvantage Medigap (Supplement) Plans Pros: Predictable Costs: Typically have fixed premiums and cover most out-of-pocket costs, providing a clearer picture of healthcare expenses. Flexibility: Allow you to choose any doctor or hospital that accepts Medicare. Expanded Coverage: Can cover additional costs that Medicare doesn't. Cons: Higher Premiums: Monthly premiums can be higher compared to Medicare Advantage plans. Limited Benefits: Doesn't include additional services like dental, vision, or hearing coverage unless purchased separately. Not Integrated: Requires a separate policy for prescription drug coverage (PDP). Medicare Advantage Plans Pros: Lower Monthly Premiums: Often have lower or $0 premiums compared to Medigap plans. Extra Benefits: May include additional services such as dental, vision, hearing, and wellness programs. Integrated Coverage: Typically include Medicare Part D (prescription coverage) within the plan. Cons: Network Restrictions: May require you to use a network of doctors and facilities, which can limit options. Out-of-Pocket Costs: Can have copays and deductibles, leading to unpredictable costs for services. Plan Variability: Benefits might change annually, including costs and provider networks.

Excellent read! Key highlights: How are “provider-led” models like I-SNPs (Institutional Special Needs Plans) performing? Generally, they are working very well.  Provider-led I-SNPs align the provider, payor and beneficiary in a way that encourages investment in primary care and prevention. When everyone is incentivized to do the right thing, it results in better outcomes and more sustainable care. Earlier this year, ATI released a whitepaper finding that beneficiaries in these plans had fewer pressure ulcers, fall inquiries, infections and ER visits. MedPAC, in its June report to Congress, also found that residents enrolled in I-SNPs tended to live longer and had lower mortality rates than those not enrolled in an I-SNP. According to MedPAC’s data report, in 2025, 79% of Medicare beneficiaries are enrolled in managed care plans or assigned to accountable care organizations, leaving only 21% in traditional FFS. It’s essential that providers understand this evolving landscape and take steps to become more informed. That doesn’t mean they need to jump into risk arrangements immediately. There are opportunities to participate in upside-only models, which allow providers to learn and begin shifting their mindset. This positions them for future two-sided risk partnerships, such as I-SNPs. https://lnkd.in/e2pE8Mct

The Centers for Medicare & Medicaid Services late Friday released its 2026 Medicare physician fee schedule. Among the provisions in the schedule is a new Ambulatory Specialty Model, a payment model focused on specialty care for beneficiaries with heart failure and low back pain. #homecare #homehealth #medicare https://lnkd.in/gp7ejrvh

Starting January 1, 2026, Superior HealthPlan will transition its Medicare-Medicaid Plan (MMP) members to a new aligned Dual Special Needs Plan (D-SNP) called Wellcare By Superior HealthPlan. 📢 Important Update for Healthcare Providers and Stakeholders Beginning January 1, 2026, Superior HealthPlan will transition its Medicare-Medicaid Plan (MMP) members to an aligned Dual Special Needs Plan (D-SNP) known as Wellcare By Superior HealthPlan. This change, directed by CMS, ensures continued coordinated care for individuals eligible for both Medicare and Medicaid under a single, streamlined plan. Providers can access transition resources, including FAQs, provider manuals, and portal registration, at go.wellcare.com/SuperiorTX. Additionally, the Texas HHSC will host a webinar on November 20, 2025, to support providers in understanding the enrollment alignment between D-SNP and STAR+PLUS plans. Offical statement URL : https://lnkd.in/gJMgt5Mi #Healthcare #MedicareMedicaid #DSNP #SuperiorHealthPlan #Wellcare #ProviderUpdate #TexasHealthcare

Questions are flying ahead of Centers for Medicare & Medicaid Services' release of the final rule for the 2026 Medicare Physician Fee Scheduled (MPFS) this fall. In "2026 Proposed Medicare Physician Fee Schedule: Key FAQs and Proposed Changes Explained, " PYA experts answer pressing questions on the proposed rule, including: --> What is the efficiency adjustment to work relative value units (work RVUs), and who would be most affected? --> What changes are being made to practice expense (PE) RVUs, and who would be most affected? --> What are the updates to telehealth and supervision rules? --> How will these changes affect financial assistance and subsidies paid by hospitals? Get the answers here: https://bit.ly/4ojLxxZ