Travis Beaven

I'm stretching a theory to lace all the CMS model releases over the last 12 months together and give kudos to CMS cleverness. Its tough to name all the CMS models released in the last 12 months without missing an acronym. ACCESS. MAHA ELEVATE. LEAD. BALANCE. ASM. and so on. When you read the specs, they're solving varying problems like drug pricing, chronic disease, digital health, accountable care, etc. Individually it makes sense they are targeting unique objectives but collectively, is CMS telling a story they're not explicitly talking about in public? What if it's not disease-specific? What if it's not diabetes or obesity or cost containment? What if it's not about the best tech to engage? What if CMS is subtly underpinning each one as a change agent toward the American healthcare consumer's behavioral readiness to change? Elephant in the room? You can't expect someone to change until they are ready to make that change? Using that lens...here are alternative angles at what each model requires to succeed: ACCESS ties payments to outcomes in chronic disease, but includes depression alongside hypertension and diabetes. Mental health needs addressed with chronic condition management. You cannot move a BP number in a patient who isn't mentally ready to engage. MAHA ELEVATE funds lifestyle interventions Medicare doesn't cover like nutrition, physical activity, etc.. and CMS reserved a tranche specifically for dementia prevention, where some would say its all about lifestyle modifications early on, sometimes decades before it clinically shows. LEAD gives ACOs tools to reward patients for healthy eating, physical activity, and chronic disease prevention over a 10-year horizon long enough for behavioral changes to actually set in. BALANCE, the GLP-1 access model, only works if patients sustain the behavioral changes that make those drugs effective. Without readiness it'll just end up being a temporary result. None of these models work if the patient isn't ready to change. Surround someone with tech, coaching, meds, and incentives but if they don't believe change is possible, if their life isn't stable enough to prioritize it, if they don't trust the system, the impact will be short term. Much like many models before them. What feels different this time is behavioral readiness showing up in the payment architecture. OAPs lace engagement to change to outcomes. 10 year ACO structures mean providers are on the hook long enough for change to set in. Prevention pilots start reimbursing the "not yet sick." I am not claiming to be the mystic seeing the forest through the trees, but it is the first time I've thought about the interconnected web CMS is spinning up in a different way. So instead of betting on coding games, advanced tech, utilization strategies, etc...we may have just watched CMS place strategic bets on building the infrastructure to make patients ready to engage with the system intended to help them get or stay healthy.

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Thanks, Jim Apodaca, for the thoughtful conversation and the opportunity to join The Execution Gap. One of the themes we explored is something I see repeatedly in healthcare interoperability: great strategies fail when they collide with operational reality. Standards, policies, and transformation initiatives only succeed if they can survive real workflows, real data, and real people. Execution is where interoperability actually lives. 🤺 I appreciated the chance to talk through the practical side of turning strategy into systems that work in the real world, from reducing rework and variability to building the guardrails that make progress sustainable. Grateful for the conversation, Jim. 🙏 I enjoyed it. 🤩 If you're working on healthcare interoperability, data quality, or digital transformation, I hope you find the discussion useful. 😘 🎙️ Watch the episode here: bit.ly/laura-nixon-podcast

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Don't miss this conversation with Firely about how #healthplans and #providers are turning mandated expenses into high-ROI investments. What you'll learn: - CMS-0057-F at a glance: Obligations, timelines, and ROI - Scale without a rebuild - Roadmap for success - Lessons & pitfalls to avoid - Live Q&A https://lnkd.in/gw7e5Xgy

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If you're new to or interested in Product Strategy, I highly recommend the Northwestern University Kellogg Executive Education course on Product Strategy. The course material was relevant and applicable for a variety of industries - including healthcare - and Professor Mohanbir Sawhney delivered it in engaging, useful ways. Very helpful for developing a disciplined, yet flexible approach to this work that aligns with your organization's culture and goals.

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Recently, I shared some thoughts in Fierce Healthcare on a critical issue facing state agencies: managing SNAP error rates in the wake of H.R. 1. I’ve heard from many states that are anxious to address error rates and avoid financial penalties, making process modernization a fiscal imperative. The national average payment error rate, which hit 10.9% in FY2024, is largely a result of administrative strain. Caseworkers are navigating rising caseloads and legacy systems, which can unfortunately lead to delays for families who rely on these benefits. In the article, I outline how technology can serve as a powerful lever to mitigate financial risk and improve program integrity. By working smarter with technology like AI and analytics, states can reduce error rates, protect funding, and ensure benefits are delivered accurately and efficiently. Check out the full article to explore five tangible steps for implementation. https://lnkd.in/eqYwgNmb

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