Jon McBride

More sobering news for value-based care. Avalere's recently released analysis of 18 CMMI payment models showed that most lost money -- $6.4 billion over the last decade to be exact. A few community pilots saved around $2B, but the broader picture is less favorable. Maryland's All Payer and Total Cost of Care Models performed the best while one Medicare Advantage and two Primary Care models had the biggest losses. Only 4 of the 18 models demonstrated clear impact on quality. None of the models were endorsed by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) which "provides a forum where those in the field may directly convey both their ideas and their concerns on how to deliver high-value care." The analysis follows a 2023 CBO assessment that found CMMI increased the indirect spending by $5.4 billion over a decade. The simple truth remains: our value problem is primarily an infrastructure problem. VBC can’t be retrofit onto fragmented systems and expected to achieve its intended goals. It's time to rethink what VBC means and how to implement it effectively. Some thoughts: 1. Rethink CMMI’s role. Instead of designing and managing models, fund them. Time-limited grants. Measurable milestones. A formal fast-track for exploratory care models that are truly innovative. 2. Full support for new operators. Privately funded and independently developed platforms can build novel care systems with less bureaucracy and administrative burden. Deeply integrated, specialty-first, tech-enabled. They don’t need risk models to deliver great care; they do it inherently. 3. Reframe the narrative. Maybe it’s time to stop chasing “VBC” as a nebulous, undefinable concept and start building actual advanced care models—ones that optimize for quality, experience, and cost without needing policy tailwinds to function. Not value-based care but the natural progression of a better approach. The dream of high quality, engaging, cost-effective care isn't dead -- but it's probably due for a re-brand. #valuebasedcare #cmmi #innovation

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This CMS RFI is more about the technical aspects of data migration and cloud hosting, but it provides some interesting insights into design changes for the Medicare Current Beneficiary Survey (MCBS): The 2026 redesign, to be launched starting with the Fall 2026 data collection, will employ a national frame, which covers all 50 states and the District of Columbia. The sample will be stratified by state to provide approximately equal numbers of beneficiary interviews within each state. The redesigned approach will no longer rely on PSUs or SSUs, and all beneficiaries in the United States will be eligible for sampling and recruitment. In place of the PSUs and SSUs, the national frame will be partitioned by state, and within each state, beneficiaries will be selected at rates designed to preserve adequate representation of the under-65 disabled population, beneficiaries 65-79 years of age, and beneficiaries 80 years of age and older. There will no longer be additional stratification based on ethnicity. While both the current design and the 2026 redesign yield nationally representative samples, the new design will include sampled beneficiaries and completed interviews in each of the 50 states and the District of Columbia. Once fully implemented, the 2026 redesign will allow for state-level and subnational region-level estimation, while continuing to support national-level estimation for the many domains of interest. https://lnkd.in/eFxDWpvv

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𝗨𝗻𝗶𝘁𝗲𝗱𝗛𝗲𝗮𝗹𝘁𝗵 𝗖𝗿𝗲𝗮𝘁𝗲𝘀 𝗡𝗲𝘄 𝗕𝗼𝗮𝗿𝗱 𝗖𝗼𝗺𝗺𝗶𝘁𝘁𝗲𝗲 𝘁𝗼 𝗢𝘃𝗲𝗿𝘀𝗲𝗲 𝗞𝗲𝘆 𝗥𝗶𝘀𝗸𝘀 UnitedHealth Group (UHG) has established a new Public Responsibility Committee of its board of directors to strengthen oversight of financial, regulatory, operational, and reputational risks. The committee will monitor areas such as underwriting, regulatory relationships, merger activity, pharmacy benefit management practices at Optum, and prior authorization and claims processes at UnitedHealthcare. The committee will meet quarterly, coordinate with other board panels, and focus on maintaining a mission-oriented public perception, including addressing shareholder concerns about consumer practices. The move follows heightened scrutiny of UnitedHealth’s policies in the wake of recent controversies. Alongside this step, UnitedHealth named F. William McNabb as its lead independent director.

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Is your digital health strategy strengthening rural systems—or quietly draining them? The Executive Quick Start Guide outlines how to build rural first regional digital health networks that: ✅ Expand specialty access without exporting patients ✅ Use telehealth, eConsults, and RPM with clear escalation rules ✅ Align multiple organizations around shared outcomes Designed for leaders responsible for regional alignment, not one-off pilots. 📘 Explore the guide https://lnkd.in/gNTPnxMn #RegionalHealth #HealthcareStrategy #RuralHospitals #Telehealth #PopulationHealth #DigitalHealth #RuralHealth #HealthcareLeadership #eConsults #RemotePatientMonitoring #SpecialtyCareAccess

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It had to be said! 🎯 Epic's stranglehold on healthcare IT has stifled innovation for too long and the writing is on the wall. The consolidation myth needs to die already. We were promised efficiency and lower costs, but what we got was bloated bureaucracies that prioritize profits over patients. The data doesn't lie: smaller, agile providers consistently outperform these healthcare monopolies on both outcomes and patient satisfaction. Time for a major reset in how we think about healthcare delivery.

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The shift in Star Ratings underscores a persistent tension between measurement and meaning — we streamline metrics yet risk overlooking what truly drives health outcomes that is relational longitudinal care.

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Today’s Situation Report offers a roundup of the latest news in federal health policy like payers aligning with CMMI’s ACCESS model as questions emerge about financial viability, CMS ending its signature primary care model early, new FDA modernization proposals, the agency’s reversal to review Moderna’s flu vaccine, and insurers accelerating AI adoption for oversight.  We’re also sharing a new action opportunity: the EMERGE Initiative is gathering input on how changes to federal statistical data have affected researchers, practitioners, and policy work. If federal data disruptions have impacted your work, you can share your experience through their anonymous survey: https://lnkd.in/e5ppE3y5  Read more here: https://lnkd.in/e-fuihzN 

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Puerto Rico’s healthcare community is driving meaningful change from advancing digital transformation to strengthening resilience across hospital systems. At the Asociación de Hospitales de Puerto Rico Annual Convention 2025, Interlace Health joins the conversation on how smarter, connected workflows can help hospitals improve care delivery, compliance, and efficiency. Read the full story: https://bit.ly/43zyjof

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