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CMS Health Tech Trends: The Rise of the Active Patient
The April 9th CMS Health Tech Ecosystem Live event highlighted a meaningful shift in how healthcare data is being accessed and used. For years, interoperability has been discussed in terms of systems—connections between payers, providers, and networks. That framing is changing. Patients are no longer passive recipients of care—they are becoming active participants in how…
Read MoreA Blueprint for Advanced Interoperability
One of the things I appreciate most about TEFCA is that it is not just a framework for exchange — it is a framework for disciplined trust. Recently, a nuanced discussion emerged around directory requirements and technical implementation. At the center of it was something that might sound small: how an organization’s address is represented.…
Read MoreTEFCA Continues to Scale
TEFCA has entered its next phase. It is operating at volume. It is expanding across the ecosystem. It is scaling as national infrastructure. Participation continues to grow. Exchange activity is increasing. Use cases are broadening. What began as alignment around a Common Agreement is steadily becoming embedded in how health information moves across the country.…
Read MoreFrom Pilots to Paychecks: Why CMMI’s New Models Matter for Risk Adjustment and Quality
The CMS Innovation Center (CMMI), created by the Affordable Care Act (ACA) in 2010 under Section 1115A, designs, tests, and scales payment and service‑delivery models that improve quality while lowering cost across Medicare, Medicaid, and CHIP, launching 50+ models to date, from ACOs to bundled payments. Recently, they released a flurry of new models, and…
Read MoreTEFCA Is Maturing — and That’s a Good Thing
TEFCATM was always intended to be a living framework. The latest SOP updates released by the RCE in January 2026 reinforce that vision and represent an important step in TEFCA’s evolution from foundational policy into operational maturity. This round of updates brings needed clarity to how TEFCA is executed—especially around response obligations, IAS participation, and…
Read MoreFrom Disruption to Design: Turning Compliance into Competitive Advantage in 2026
Healthcare organizations are facing unprecedented regulatory pressure in 2026 due to a convergence of political, economic, technological, and enforcement forces. Political volatility, driven by election cycles and shifting federal priorities, creates uncertainty as administrations introduce new healthcare agendas, while state-level regulations add complexity for multi-state systems. Heightened public accountability is also fueling stricter mandates, with…
Read MoreIndustry 5.0 and the Rise of Intelligent Risk Adjustment
In the age of Industry 5.0, healthcare is evolving beyond automation and efficiency toward a value-based model that emphasizes human-centric innovation, intelligent collaboration, and strategic data use in population health management. This shift is especially evident in risk adjustment, where the synergy between clinical expertise and advanced technologies like artificial intelligence (AI) and analytics is…
Read MoreClosing the Loop on Referrals: A Framework for Health System Success
Health systems are losing millions each year to referral leakage, with studies showing up to 65% of referrals leaving the network. Beyond lost revenue, leakage fragments care, erodes quality scores, and frustrates patients and providers. Market and policy pressures make it critical to address this issue now. CFOs demand ROI, clinicians face burnout, and centralized…
Read MoreNavigating the Financial Fallout
How Providers Can Proactively Prevent Bad Debt and Uncompensated Care Amid H.R. 1’s Medicaid Changes The passage of H.R. 1, also known as the “One Big Beautiful Bill Act,” marks a significant shift in the U.S. healthcare landscape, particularly for Medicaid. With sweeping changes to eligibility, enrollment, and cost-sharing, the legislation is expected to increase…
Read MoreProactive Precision: Sharpen the Tools in Your RADV Preparation Toolbox
The Centers for Medicare & Medicaid Services (CMS) recently signaled a dramatic escalation of its efforts to combat fraud, waste, and abuse in Medicare Advantage (MA), and has committed to the sharpening of its tools to accomplish this goal. With the recent announcement that CMS will begin auditing all eligible MA contracts each payment year and…
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