Medicare policy debates keep returning to one question: Does Medicare Advantage (MA) deliver better quality than traditional Medicare after accounting…
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Electronic health records (EHRs) are built to document care, and they do it well. When a patient’s condition starts to…
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Digital quality measurement now has dates attached. In the Calendar Year 2027 Physician Fee Schedule proposed rule, the Centers for…
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Over the past few months, I have sat in on more than a dozen conversations with health plan quality teams about digital quality…
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On July 14, 2026, CMS released the Medicare Shared Savings Program (MSSP) 2027 Proposed Rule as part of the CY2027 Physician Fee Schedule…
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On June 9, 2026, CMS informed Clover Health that its 2026 Medicare Advantage Star Rating was no longer 3.5 stars —…
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The pressure on healthcare payers has never been higher: do more, spend less, move faster. With nearly $496 billion spent annually on healthcare administration, tightening…
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For risk adjustment VPs, directors, and managers, the CY 2027 CMS Advance Notice signals lower MA scores, stricter diagnosis-source rules,…
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CMS recently released its Contract Year (CY) 2027 Proposed Rule – a 465-page set of proposed updates that could reshape both Medicare Advantage Star Ratings performance and…
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CMS released their Proposed Rule, and it signals meaningful change for the Medicare Advantage Star Ratings program. From methodology updates to measure removals and enrollment flexibility,…
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Value-based care (VBC) is no longer a primary-care-only strategy. As health plans broaden their models, they’re increasingly tying incentives to performance across…
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Every HEDIS® season tells the same story, but with very different endings. In our recent poll, 38% of healthcare quality professionals…
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Even as CMS Star Ratings begin to stabilize, many health plans still feel in the dark — but some plans…
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In value-based care, shared goals between health plans and providers are only possible when both parties are working from the…
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If you’re tired of stitching together data from multiple systems just to answer a single question, you’re not alone. Healthcare…
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For more than 15 years, value-based care (VBC) has transformed healthcare by shifting the focus from volume to outcomes. Initially,…
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The Centers for Medicare & Medicaid Services (CMS) has finalized updates to the Medicare Advantage (Part C) and Medicare Prescription…
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Many quality professionals are feeling anxious about the transition to digital quality measures (dQMs).
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NCQA recently shared proposed new measures and measure changes for MY 2026 for public comments. The following is a summary…
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The Medicare landscape is poised for significant changes with the release of proposed rules from the Centers for Medicare &…
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Healthcare data is more than simply a byproduct of care – it’s the foundation for smarter decisions, better care delivery,…
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Are you ready to tackle the challenges of HEDIS® Measurement Year 2024 (MY24)? Whether you are a seasoned expert or…
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Star Ratings for Medicare Advantage (MA) plans affect reimbursement and member retention, so it’s important for plan leaders to understand…
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