CMS publishes the 2027 Medicare Advantage Star Ratings today. One number sets the 2028 quality bonus, goes public on Plan Finder immediately, and feeds a bid not filed until June 2027.
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Medicare Is Contracting Directly With Technology Companies, and the Program Is Expanding
The CMS Innovation Center’s ACCESS Model contracts technology organizations to partner with Medicare physicians on chronic disease. New clinical tracks are coming next spring.
Medicare Advantage Star Ratings Thresholds Just Got Harder for 2027
CMS released draft 2027 cutpoints to plans in September, raising many of the thresholds. Official results are due out in October. For vendors, the buying window is now.
Medicare Built an AI Prior Authorization Program. The Records Are Not Flattering.
About a thousand pages of CMS records concerning Medicare's AI prior authorization pilot were released in mid-September through a Freedom of Information Act lawsuit brought by the Electronic Frontier Foundation. They are worth reading closely if you sell artificial...
Member Story: How PeopleOne Health Helped a Busy Mom Catch a Health Issue Early
Sometimes, the most important healthcare moments happen before you know you need them. For busy working parents, finding time for routine care can easily fall to the bottom of the list. But Leighโs story is a powerful reminder of why preventive careโand having access...
Joint Replacement Goes National: CJR, TEAM, and the Expanding Episode Market
The FY 2027 inpatient payment rule, finalized July 31, 2026 and effective October 1, 2026, does something easy to miss in a two-thousand-page document. It nationalizes the Comprehensive Care for Joint Replacement model, with mandatory participation beginning January...
Thatch Crosses $1 Billion โ ICHRA Crosses Into the Mainstream
๐ $๐๐๐ ๐ฆ๐ข๐ฅ๐ฅ๐ข๐จ๐ง ๐๐๐ซ๐ข๐๐ฌ ๐ ๐ฏ๐๐ฅ๐ฎ๐๐ฌ ๐๐ก๐๐ญ๐๐ก ๐๐ญ $๐ ๐๐ข๐ฅ๐ฅ๐ข๐จ๐ง. ๐๐ก๐ ๐ง๐ฎ๐ฆ๐๐๐ซ ๐ข๐ฌ ๐ญ๐ก๐ ๐ก๐๐๐๐ฅ๐ข๐ง๐; ๐ญ๐ก๐ ๐๐จ๐ฌ๐ญ ๐๐ฎ๐ซ๐ฏ๐ ๐๐๐ก๐ข๐ง๐ ๐ข๐ญ ๐ข๐ฌ ๐ญ๐ก๐ ๐ฌ๐ญ๐จ๐ซ๐ฒ. Congratulations to the Thatch team โ $108M Series C at a $1 billion valuation. Three numbers worth sitting with: Revenue up roughly 7x since the...
Medicaid’s Retroactive Coverage Window Shrinks in 2027
A quiet change in the Medicaid rules will show up in hospital bad debt. Today, Medicaid can cover medical bills incurred up to three months before someone applies. Beginning January 1, 2027, that retroactive window drops to one month for adults ages 19 to 64, and two...
New Telehealth Modifiers: CMS Is Building a Dataset, Not Changing a Payment
CMS is about to start watching something it says it has no plans to change. Beginning January 1, 2027, Medicare telehealth claims will carry a new modifier when the billing practitioner has a contract or payment arrangement with the company that owns the virtual...
Revenue Quality in Remote Monitoring
A useful distinction that most remote monitoring diligence skips: revenue quality, not revenue growth. CMS has proposed that remote monitoring be payable only when the clinical staff are direct employees of the billing practitioner's practice. Outsourced clinical...