Most complex-care programs are built around adding things: a care manager, a home visit, a new care plan, another touchpoint. It is an addition-shaped instinct in a field that rewards visible activity. For a large share of your frailest, highest-cost patients, the highest-value intervention available is subtraction — and it is sitting in a cabinet […]
Eleven Medications. Three of Them Are Causing the Problems. Read More »
CMS released the ACO REACH Performance Year 2024 financial and quality results on July 9, 2026. The headline is genuinely good: net savings to CMS of approximately $988.3 million, with gross savings up more than 53% over PY2023. Then you read one more line in the results, and the story changes completely — in a
CMS Banked $988 Million. The ACOs Earned 5% of It. Read More »
For three years, the entire Medicare Advantage risk-adjustment conversation has been about V28 — the phase-in, the lost codes, the revenue hit, the scramble to adapt. That conversation is now largely over, and it ended in a way few people expected. MedPAC’s March 2026 report to Congress says, in effect, that V28 did its job.
V28 Worked. That’s Not the Story Anymore. Read More »
Walk into almost any risk-adjustment discussion this year and you will hear some version of the same sentence: CMS now extrapolates RADV audit findings across your entire contract. Vendors say it. Consultants say it. I have said a version of it myself. As of today, it is not accurate — and the organizations that understand
Everyone Is Wrong About RADV Extrapolation Right Now Read More »
Take two 78-year-olds with the same conditions on paper — diabetes, hypertension, mild kidney disease — and the same risk score. One golfs twice a week. The other has fallen twice this year, lost fifteen pounds, and can no longer manage her own medications. Your risk model sees them as the same patient. They are
Same Diagnoses. Same Risk Score. One of Them Dies This Year. Read More »
Here is a contradiction sitting at the center of most value-based organizations, in plain sight. The organization is paid to keep a population healthy and hold down total cost of care. The physicians inside it are still, overwhelmingly, paid to do more — more visits, more procedures, more RVUs. You have signed a value contract
You Signed a Value Contract and Kept a Volume Paycheck Read More »