Health Care Matters | May 15
Celebrating Three Years of Coral Health Advisors
Today, Coral Health Advisors is celebrating three years of partnership, growth, and impact. What began as a small team with a shared belief that health care transformation should be practical, collaborative, and outcomes-driven has grown into a firm supporting organizations across the country on some of the most complex challenges in health policy and value-based care.
Over the past three years, we’ve had the privilege of working alongside health plans, providers, states, ACOs, foundations, and innovators to advance accountable care, payment reform, rural health transformation, population health, and operational implementation. We are proud of the work, but even more proud of the relationships, trust, and shared commitment that made it possible.
To our clients, collaborators, partners, and readers: thank you for being part of this journey with us. We are deeply grateful for the opportunity to learn alongside you, support your work, and contribute to the ongoing transformation of health care. We’re just getting started.
CMS Freezes New Hospice and Home Health Medicare Enrollments Amid Fraud Crackdown
CMS recently released new communications and implementation resources focused on electronic prior authorization, reinforcing the agency’s broader interoperability agenda and encouraging stakeholders to accelerate readiness efforts ahead of the January 1, 2027 compliance deadline. The agency’s new overview materials emphasize that impacted payers must implement FHIR-based Prior Authorization APIs, along with related Provider Access and Payer-to-Payer APIs, under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). CMS is also expanding its voluntary Health Tech Ecosystem initiative to additional stakeholders, including providers, health systems, EHR vendors, and digital health companies, while continuing to encourage workflow digitization and standards-based interoperability. Read the announcement here.
Why It Matters
The scale and scope of the moratorium stand out. CMS has historically used more targeted enrollment freezes in select markets, but a nationwide pause signals a broader level of concern about the integrity of the hospice and home health sectors. It also comes at a moment when care in the home is becoming more central to Medicare strategy, from aging-in-place priorities to the extension of the Acute Hospital Care at Home waiver through 2030. That creates policy tension with federal leaders encouraging more care to shift into home-based settings, while also signaling that growth in these sectors will face much closer scrutiny. The moratorium may slow legitimate new entrants alongside problematic ones, particularly in underserved areas, but it also reflects CMS’ growing willingness to use enrollment authority as a front-end program integrity tool rather than relying only on retrospective audits and enforcement.
Look for the Helpers: Former School Reimagined as Community Health and Resource Hub
An abandoned elementary school on San Antonio’s South Side is being transformed into a community hub that will house behavioral health services, nonprofits, food assistance programs, and care navigation resources designed around local needs. The project grew out of neighborhood input and reflects a broader effort to create spaces where health, social services, and community support exist side by side rather than in separate systems. Read here.
What We Are Reading
Ready, Set, Go: Implementation of Medicaid Work Requirements Is on Its Way
A McDermott+ blog examines how states are beginning to operationalize Medicaid work requirements following renewed federal openness to community engagement policies, including early implementation planning, waiver activity, and administrative considerations tied to eligibility tracking and reporting. Read here.
Keeping Patients First: A Blueprint for AI in U.S. Healthcare
An OpenAI policy blueprint outlines recommendations for expanding patient-directed data portability, modernizing AI regulation, and supporting clinician-supervised AI adoption in healthcare, while arguing that interoperability and workflow integration will be critical to scaling responsible AI use across the system. Read here.
California’s Spending Growth Target Initiative: Insights From Commercial Total Medical Expense Reporting
Health Affairs Forefront published an article examining early findings from California’s statewide spending growth target initiative, using commercial total medical expense reporting to highlight variation in health care cost growth across markets and service categories. Read here.
A Sleeping Giant of Health Care Affordability — Self-Insured Employers
A New England Journal of Medicine perspective argues that self-insured employers remain one of the most underutilized levers in health care affordability, despite their growing influence over benefit design, purchasing strategy, and value-based payment adoption. Read here.
State Strategies to Strengthen Perinatal Health Care Systems and Postpartum Care
NASHP recently published a resource which highlights how states are using Medicaid policy, care coordination, workforce strategies, and maternal health initiatives to strengthen perinatal care systems and improve postpartum support for mothers and infants. Read here.
