The Coral Blog
Expert perspectives on policy, performance, and system change.
The Coral Blog is where we break down what’s happening in health care and what it means for leaders working to improve outcomes and affordability. Drawing from our cross-sector experience, we offer commentary that connects the dots between regulation, strategy, and operations.
CMS Announces New Preventive Health Model: What You Need to Know About MAHA ELEVATE
CMS has announced the MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) Model, a new voluntary initiative aimed at transforming how Original Medicare approaches chronic disease prevention and whole-person wellness.
CMMI Launches New Technology-Supported Chronic Care Model: What You Need to Know About ACCESS
The Centers for Medicare and Medicaid Services Innovation Center (CMMI) has announced the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, a new ten-year voluntary payment model designed to support continuous, technology-enabled care for Medicare beneficiaries with common chronic conditions.
Key Focus Areas in State Rural Health Transformation Program Initiatives
After analyzing 37 state Rural Health Transformation Program applications that are now publicly available, Coral has identified emerging models, unexpected approaches, and promising experiments that signal where rural health care is headed. Our National Themes and State Initiative Tracker includes this analysis, a state-by-state initiative matrix, and an inventory of links to public applications.
Three Things States Should Know Before Applying for CMMI’s Innovation in Behavioral Health Model
In January 2024, the Center for Medicare & Medicaid Innovation announced the Innovation in Behavioral Health model, an eight-year initiative that funds states to encourage behavioral health providers to integrate physical and behavioral health care within a behavioral health setting for adults with moderate to severe mental health conditions and substance use disorders.
Reading Between the Lines: What Paragon’s Reform Agenda Signals for the Innovation Center
A new report from the Paragon Institute, "How to Reform the CMS Innovation Center with a Choice and Competition Approach," offers a view into how the Trump administration may be thinking about the Center for Medicare & Medicaid Innovation (CMMI). Beyond its critique of the past decade of spending and model design, the report reads like a framework for where CMMI may be headed and, in many ways, aligns with what we're already seeing emerge from the Innovation Center.
Bridging Medicaid and Public Health: Turning Shared Goals into Shared Systems
As states face mounting budget pressures, workforce shortages, and rising rates of preventable disease, one truth has become clear: Medicaid and public health can no longer afford to work in silos. The National Association of Medicaid Directors’ new resource, A Medicaid Leader’s Playbook: Action Steps to Building Public Health Partnerships, offers a practical roadmap for how agencies can work together to improve outcomes and maximize impact.
3 Key Takeaways from the Heartland Conference on Health Equity & Patient-Centered Care
The Heartland Conference on Health Equity and Patient-Centered Care brought together over 300 participants from across the Midwest to tackle the complex challenge of bridging urban and rural health equity. Three critical insights emerged that will reshape how organizations approach equity initiatives in today's political environment.
CMMI’s GLP-1 Model: Why GLP-1s are a Policy Test Case for High-Cost Drugs
GLP-1 therapies have rapidly moved from niche treatments for type 2 diabetes to household names shaping conversations about obesity, cardiovascular risk, and long-term population health. Alongside their rapid uptake has come intense attention from policymakers and payers, who are weighing how to balance affordability, access, and evidence.
The Rural Health Crisis Requires More Than Money—It Demands Strategy
Sixty million Americans depend on rural hospitals and clinics for their care, yet these facilities are disappearing at an alarming rate. Emergency funding has repeatedly failed to stop the bleeding because it treats symptoms, not causes. The new $50 billion Rural Health Transformation Program offers states and the people who depend on care in rural communities an unprecedented chance to fundamentally reimagine how rural care works.
Transforming Rural Health: What States Need to Know About the $50 Billion Rural Health Transformation Fund
Rural hospitals and health systems are vital access points for millions of Americans, but for decades, they’ve faced structural and financial challenges that make long-term sustainability difficult. Now, with the launch of the Rural Health Transformation Fund, states have a new opportunity to invest in rural health care in a way that is both transformative and accountable.
CMS Proposes New Mandatory Specialty Care Model: What You Need to Know About ASM
ASM is a five-year, mandatory model that will hold outpatient specialists accountable for their performance on relevant quality, cost, care coordination, and electronic health record use metrics. The model specifically targets heart failure and low back pain. The model maintains fee-for-service payment, but retrospectively evaluates performance on cost and quality metrics, with payment adjustments based on performance outcomes.
Inside the WISeR Model: CMS’s First Tech-Only Innovation Initiative
CMS is launching a first-of-its-kind model that puts technology companies at the center of Medicare’s prior authorization process with the Wasteful and Inappropriate Service Reduction (WISeR) Model. The WISeR Model aims to focus health care spending on services that improve patient well-being, apply lessons learned from commercial payer prior authorization processes that may be faster, easier, and more accurate, increase transparency of existing Medicare coverage policy, and de-incentivize and reduce the use of medically unnecessary care.
Three Key Takeaways from the CMS Quality Conference
The prominence of program integrity discussions at this year's CMS Quality Conference signals a fundamental shift in how this administration is framing health care policy. Alongside the traditional focus areas of prevention, digital transformation, value-based care, and vulnerable populations, the emphasis on eliminating waste has become the connecting thread across all initiatives.
When Drug Policy Headlines Overpromise: What Sounds Like Reform but Isn’t
Every year, a few drug policy headlines make the rounds that sound like big wins. And every year, we see stakeholders scramble to respond, only to find that the impact is… a little less transformative than promised.
“We’ll Just Use the Claims Data”—and Other Famous Last Words
In theory, claims data should tell you what was prescribed, what was filled, and how much it cost. In practice, it tells a partial, delayed, and sometimes misleading version of that story.
Strategic Comment Opportunities in CMS’s iPAY 2028 Draft Guidance
The Centers for Medicare & Medicaid Services (CMS) has released its draft guidance for the Medicare Drug Price Negotiation Program for Initial Price Applicability Year (iPAY) 2028. This guidance sets the direction for how Medicare will negotiate the prices of selected prescription drugs, including, for the first time, certain drugs covered under Medicare Part B.
GLP-1s, and Everything We Haven’t Fixed Already
Skyrocketing demand, unclear coverage criteria, inconsistent outcomes data, escalating costs, and public frustration. These are symptoms of a system that wasn’t built for drug innovation at this scale or speed.
Recognizing and Supporting Informal Caregivers: A Key to a More Sustainable Health System
As the U.S. population ages rapidly, with 82 million Americans projected to be over 65 by 2050, the demand for long-term services and supports is growing. Yet, the formal caregiving workforce alone can't meet this need. Increasingly, family members and friends are stepping in to serve as informal caregivers to help older adults remain in their homes and communities.
Trump Executive Order Directing Development of New Drug Pricing Model
President Trump issued an Executive Order on April 15, 2025 focused on lowering high drug prices for Americans, reinforcing a goal set in his previous administration.
NAACOS Spring Conference Unpacked: Coral’s Field Notes
The National Association of ACOs (NAACOS) held its annual spring conference in Baltimore April 22-24. The event brought together NAACOS members, industry thought leaders, and businesses building innovative tools for value-based care and health system transformation.