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Housing is a human right, and it is a win-win in terms of costs to society. I see this in study after study (check Health Affairs articles on housing) and I see it on the ground in my work as an appointed Boulder official.

REACH was wildly successful and there’s even higher hopes for LEAD. Here’s what was achieved:

Your payer partners' financial pressure is your contract pressure. CMS is proposing some major shake-ups in MA for risk adjustment and Stars. Here’s a quick summary for both. For providers in VBC deals, this is going to directly impact the terms of your contracts.

LEAD vs. REACH: What's actually new. No pussyfooting around - let’s get right to it. Benchmarking - This one is pretty huge. No more rebasing. Specialists - LEAD has built-in infrastructure for downstream episode-based risk between ACOs and Preferred Provider specialists (CARA)

Patient reported surveys just don’t cut it. -- Response rates are low -- They’re biased towards more privileged patients -- And they’re often gamed (see my last post) So what to do about it?

One of the major challenges i see repeatedly in my world is it’s extremely difficult to align incentives with outcomes. Here’s an example from the Medicare Advantage space, the Star ratings.

“AI won’t take your job. Someone using AI will.” I’m sure you’ve heard this before, but it’s not completely true. What we’re seeing in health care is that reliance on human connection insulates many from mass AI-driven job loss. What’s really happening is a role shift.

New mandatory model from CMS, Ambulatory Specialty Model, targets Specialists in 25% of CBSAs. I was reading up on this and it’s really MIPS with some tweaks for specialists (a broad list) who treat heart failure or low back pain. Here’s the tweaks and how to know if you’re impacted:

Senate Democrats are signaling their priorities for healthcare reform. They’re largely focusing on the ACA marketplace given the large disenrollment and doubling in premiums, but for providers in the value-based contracts there are some important points to watch out for.

Hospitals drive healthcare costs more than insurance and physician billing and AI is likely to make it worse (or at the very least further bifurcate the market). A thread:

Continuing on the Vivian Ho fest from yesterday, let's talk about her paper "Nonprofit Hospitals: Profits and Cash Reserves Grow, Charity Care Does Not," Health Affairs, June 2023. Between 2012 and 2019, mean nonprofit hospital operating profits grew from $43M to $58.6M, but

What gives me hope is how many are working to improve our health system. Economist Vivian Ho has spent her career studying the factors leading to rising costs. I've been reading through her studies after listing to her interview on @AnArmandaLeg. I found

As of January 2025, over 53% of traditional Medicare beneficiaries, more than 14.8 million people, are now in accountable care relationships, the largest annual increase since CMS began tracking this metric.

741 hospitals are now mandated to participate in CMS TEAM as of January 1, 2026. This means that bundles are no longer optional. By definition, all costs must be managed within a single fixed episode payment. This means you really only have two levers to pull:

VBC contracts are creating a new reinsurance frontier that existing actuarial tools weren't built for. What we see everyday is that pricing reinsurance to match the risk of a VBC contract is a gift that just keeps giving in terms of challenges. Let me give you a sense of the complications:

This week seems to be revolving around hospital systems. My sense is that with the additional CMMI programs and the increases to our uninsured populations, hospital systems are feeling attacked from every angle (and thus the increase in news and posts).

CMS has been doubling down on pushing hospital systems into risk with programs like TEAM and AHEAD. Readmissions, SNF quality issues, and poor handoffs and post-acute care costs now directly hit hospital margins.

We all know there’s waste in the health system (~$750B annually), and many in my circles are working to reduce it. A recent Becker’s webinar featuring Dr. Mogul Mira (Illumicare/Premier) and Susan Hughes from Ardent Health shared their experience tackling this problem.

People don't want AI to replace human touch. They want it to make their life's easier, to remove barriers of access / cost and their work easier. From a business perspective, people want the same thing, but they want it in terms of bottom line and quality of experience / output.

Knowing your BATNA is a VBC skill. Scripps didn’t exit Medicare Advantage emotionally. They exited it analytically. They understood their margins, their admin burden, their alternative revenue path, and negotiated accordingly. buff.ly/1Bl9Eew

We don’t have a data problem. We have a decision problem. This MIT Press / Harvard Data Science Review article makes a point that quietly explains a lot of frustration in healthcare analytics: Better models don’t automatically lead to better decisions.

A new study confirms a familiar pattern (but with commercial data): Primary care intensity matters most for medium- and high-risk patients, and the relationship is nonlinear. There’s a clear inflection point where additional primary care stops producing savings and can even increase total cost.

One of the most common challenges we see in healthcare analytics: “We don’t have enough historical data to run a clean study. What do we do?” Recently, we ran into this in a pricing engagement. The client’s internal experience wasn’t deep enough to support a traditional trend analysis.

I enjoyed this paper from JAMA Health Forum that looks at how physician payment incentives are playing out globally. A few fun (and unsurprising) facts from across countries: 1) Pay-for-performance programs are now common in Europe, the UK, Australia, and parts of Asia, not just the U.S.

Happy Advanced Notice week to those that celebrate (a week late)! This year’s gift was… subtle. From a policy perspective, the 2027 Medicare Advantage Advance Notice signals stability. From a value-based care perspective, it signals opportunity.

Over the past few months, our team has been formalizing how we use AI in actuarial and analytics work and one thing it painfully clear: AI absolutely boosts productivity, but only when it’s actively managed and governed.

Highlights from this week’s edition of The Monitor: 💊 Have FDA decisions about the abortion pill consistently followed scientific evidence? 🤖 Google’s removal of some AI-generated summaries for search results about health topics. Read and subscribe: https://on.kff.org/4a6fn2W

Abortion Pill Safety Decisions by FDA Were Science-Based, New JAMA Study Finds — The Monitor | KFF

A new study found the FDA’s abortion pill decisions followed scientific evidence, as misleading claims about the drug’s safety continue to shape public understanding. And Google removed some health AI...

on.kff.org

When hospitalized detainees can’t be found by family members or attorneys, advocates say, it leaves patients vulnerable to abuse and isolation and deprives them of their constitutional right to counsel. Read the full story ⤵️

‘I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees - KFF Health News

Some hospitals are registering patients detained by federal immigration officers under pseudonyms and prohibiting staff from contacting family members. Attorneys and health care workers say the practi...

kffhealthnews.org