Health Care Matters | July 24
CMS Signals a Broader Role for Health Technology in Medicare Payment Models
In a recent conversation with StartUp Health, Centers for Medicare & Medicaid Services (CMS) Deputy Administrator and CMS Innovation Center (CMMI) Director Abe Sutton described affordability and measurable outcomes as central to the agency’s approach to health technology. Sutton pointed to the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, which uses recurring payments tied to improvements in chronic conditions, and Geo AHEAD, which will allow technology companies and other non-provider organizations to help lead entities accountable for previously unattributed Medicare beneficiaries in participating regions. He also emphasized that proposals brought to CMS must address system-level challenges and present a credible path to reducing Medicare spending. Read here.
Why It Matters
The significance is not that CMS is opening Medicare accountable care arrangements to technology companies for the first time. Direct Contracting and ACO REACH created pathways for purpose-built and other nontraditional organizations to participate as accountable entities, and CMS previously explored a geographic accountability model through Geographic Direct Contracting. What is notable in Sutton’s comments is the agency’s increasingly explicit focus on designing payment approaches around technology-enabled care. ACCESS represents the clearest departure by creating recurring Medicare payments tied directly to measurable improvements in chronic conditions. Geo AHEAD builds on earlier accountable care approaches but reinforces that technology companies and other non-provider organizations may have a role in leading population-based arrangements when they can integrate with care delivery and demonstrate improved outcomes, affordability, and accountability for total cost of care.
Look for the Helpers: Helping Community Health Workers Build a More Sustainable Future in New York
North Carolina’s Healthy Opportunities Pilots connected Medicaid beneficiaries with food, housing, transportation, and other services through local community organizations. A new collection of stories from participants, care managers, and service providers shows how that support helped people manage health conditions, regain stability, and feel less alone while navigating difficult circumstances. It is a reminder that meaningful improvements in health often begin with people who understand their communities and are ready to respond to what residents need. Read here.
New Resource
Coral Health Advisors’ Rural Health Transformation Program Tracker
Coral Health Advisors has launched a new tracker to help organizations monitor RHTP activity across states. The tracker brings together state updates, procurement opportunities, webinars, deadlines, and other key developments in one easy-to-navigate dashboard, with filters and preferences that allow users to focus on the states and topics most relevant to their work.
With the purchase of the RHTP Tracker, subscribers will also receive complimentary access to Coral’s grant toolkit. The toolkit provides practical guidance to help organizations prepare for RHTP-related opportunities, including eligibility considerations, proposal development, budgeting, and post-award readiness.
Learn more about the RHTP tracker in this product demo.
If you have any questions or would like to learn more about subscription options, please don't hesitate to reach out at info@coralhealthadvisors.com
What We Are Reading
NASHP’s Behavioral Health Workforce Repository: Resources from Our Policy Academy
A new National Academy for State Health Policy repository compiles state examples and resources on behavioral health career pathways, scopes of practice, workforce data, and regulatory modernization. Read here.
Medicare Advantage Quality Bonus Program: Court Decisions Spotlight Flaws
A Health Affairs Forefront article examines how recent court challenges to Medicare Advantage star ratings could increase federal payments while adding to longstanding concerns about whether the quality bonus program improves care or helps beneficiaries compare plans. Read here.
Pop Health Podcast
Turning Denial Appeals Into a Faster Workflow
In this episode of Bright Spots, Coral’s Kate Freeman speaks with Gretchen Heinen, Founder and CEO of Authsnap, about how AI-enabled tools can help reduce the administrative burden of insurance-denial appeals and medical-necessity documentation. The conversation explores how Authsnap supports clinics, hospitals, and health care organizations by streamlining work that has traditionally required hours of manual review, helping providers manage growing volumes of commercial-payer and specialty-drug denials with greater speed and accuracy. Gretchen shares how her experience as a utilization-management nurse shaped the development of Authsnap, what implementation looks like in real-world provider workflows, and what tools like Authsnap could mean for the future of prior authorization, revenue cycle operations, and patient access to care.