Deborah Berini

With #CMS unleashing another ~$25B of revenue yesterday to #MA plans, the timeless adage rings true: “To whom much is given, much will be expected.” Though the Rate Announcement can’t promulgate technical updates, it delivered plenty of strategic signals for #MedicareAdvantage plans to integrate into summer planning. Here’s what we learned and why it matters: 1️⃣ No more last-minute #Stars rescue missions. CMS announced formal data dispute deadlines for the most commonly challenged measures, which ends most #PlanPreview panic. Plans need to schedule proactive data investigation processes now for MY2024 CTM/Appeals (and accelerate PDE validation next spring.) 2️⃣ SNS-E is out. CMS is no longer considering it for #StarRatings. While universal #SDOH screenings isn't a top Trump2.0 priority, last week’s FinalRule finalized a #Compliance mandate for 3 live attempts on SNP HRAs and completion within 90 days of enrollment impacting the SNP-CM measure. 3️⃣ A Technical Expert Panel has examined current measures vis-à-vis MedPAC’s recommended program changes. The TEP supports current #HEDIS, #HOS, #CAHPS and some admin measures but flagged concerns with small denominators, gameability and provider burden. They called for more clinical outcomes and reaffirmed the high stakes of #QBP. Who exactly was at this table? Unclear, but we’re still digging! 4️⃣ The foundation has been paved for more evolution. All technical changes needed to align Stars with the #MedPAC MA-VIP have now undergone required public comment, paving the way for rulemaking if/as desired. Stars likely won't evolve to MedPAC's vision via a Rip/Replace; rather, it's more likely we'll see technical updates to effectuate the evolution. 5️⃣ CMS hints at late-stage changes. In discussing Poly-CNS, CMS noted that changes announced BEFORE an MY can be finalized AFTER it begins. That subtle clarification could apply to MY2026, meaning we could see rulemaking through 12/31/25 with potential finalization in 2026. So what could all of this mean? ⭐ #HealthEquity is remains a subtext. While the term is less visible, the unmet needs of Duals, LIS-eligible and disabled beneficiaries remain the crucial cost drivers. With $880B potentially about to be stripped from #Medicaid, the $25B awarded to MA plans still leaves carriers' profits exposed. Stars and #MLR will be optimized via scaled managed care principles across high-need members. ⭐ Outcomes > Process. Concepts like #EHO4All emphasize the broader shift towards outcomes measures. Expect increased emphasis on access, experiences and outcomes metrics. ⭐ MedPAC’s vision is in range. Measures flagged for potential retirement to align Stars with MedPAC’s vision have now been commented on, clearing the path for changes as early as MY2026 if desired. If Stars is a top enterprise priority for you, as it is for most of our clients, please: ✅ Share these updates across your leadership team, and  ✅ Future-proof your summer and fall initiatives.

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🎯 “As a CEO, I have three jobs — and when I came to Catholic healthcare, I added a fourth.” At Becker’s CEO + CFO Roundtable, Eduardo Conrado, President of Ascension, shared a concise yet powerful framework for modern healthcare leadership: 1️⃣ Lead strategy 2️⃣ Match capital to that strategy 3️⃣ Align and develop the right talent 4️⃣ And above all — stay mission-driven in every decision As the healthcare landscape shifts, his message underscores a timeless truth: purpose and performance must move in lockstep. 🎥 Watch Eduardo Conrado explain how aligning strategy, capital, and talent around mission is shaping the future of Ascension. #BeckersCEOCFO #HealthcareLeadership #MissionDriven #CLevelStrategy #AscensionHealth

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Former U.S. Sen. Roy Blunt of Missouri (third from left) joins the SSM Health team in Chicago at the recent 2025 Siemens Value Partnership Forum. Blunt is a key advisor to Siemens and, two years ago, SSM Health entered into a 10-year partnership with Siemens that is expanding access to high-quality care and training the next generation of health care workers. The agreement provides state-of-the-art imaging equipment and training. SSM Health and Siemens also are developing apprenticeships in imaging technology that will provide economic opportunities for young people in underserved neighborhoods. The training is being conducted in conjunction with the Urban League and other organizations as SSM Health works as a leader in eliminating social disparities.

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Most healthcare leaders agree prior authorization is broken. Few are willing to confront the root issue: a system built on mistrust. Yesterday in Chicago, I joined a room full of leaders for a timely discussion hosted by DLA Piper, focused on charting a path forward for prior authorization. What surfaced wasn’t just policy talk. It was a call to rethink the foundation. Senator Richard Burr said it plainly: “Healthcare will financially bankrupt this country if we don’t do something.” And more importantly, “The system will not change if there are no options to consider.” The problem isn’t just process.  It’s protectionism.  Too many stakeholders are clinging to rules designed to control rather than collaborate. A real example of a little win was shared on how to align incentives to reduce prior auth burden and cost. That kind of transparency and shared alignment creates room for trust to grow. Everyone on the panel agreed: without trust, standardization won’t stick. Transparency feels out of reach. And progress stalls. The path forward centers on three actions: 1. Targeting the right episodes and provider types 2. Creating real transparency across the system 3. Rebuilding trust through data, dialogue, and shared wins The hardest part? Letting go of the rules we built to protect ourselves, and choosing instead to build for the people we serve. The location was epic, luckily we remembered to capture the moment with Amit Aysola and Leek Deng, two leaders who get it. Trust isn’t a buzzword. It’s the bridge to better care.

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The impact our local healthcare ecosystem has on the community is immense. The Minnesota Hospital Association's latest Community Impact Report shares how Minnesota hospitals helped invest $6.2 billion to improve the health and well-being of our neighbors in 2023. Not only are nonprofit hospitals like Allina Health fulfilling our charitable missions, but we also going above and beyond by delivering resources, programs and services that stabilize communities. According to the Minnesota Office of the Legislative Auditor (OLA)'s new evaluation, nonprofit hospitals appear to spend more to benefit their communities than they receive in tax credits. These findings highlight how focusing on groundbreaking treatments, reducing health disparities and training the younger generation have a positive impact on Minnesotans. Learn more about these reports at the links in the comments. #HealthCare #Community

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As of late 2024, median hospital operating margins (after accounting for system allocations) were roughly 1–2%, placing over half of U.S. hospitals in a fiscal state that challenges their long-term survivability. Furthermore, a deep divide has emerged: while a subset of high-performing hospitals have financially recovered (even improving profitability in 2023–24), a large portion have stagnated or worsened. Analyses reveals that about 40% of American hospitals continue to lose money from operations into 2024. In other words, two out of five hospitals are effectively insolvent if the status quo continues. This is an unsustainable situation that threatens access to care in many communities. Even those with positive margins are often eking out 1–3% – “historically slim” margins that are not yet fully sustainable in the face of future shocks (pandemic, inflationary surges, climate-based, tariffs, legislation, etc.) or capital needs. What’s driving this margin erosion? At DOCSI, as we look across the market and engage with our partners we see five principal factors accounting for the majority of financial strain: -------------------------------------- 1. Labor Costs 2. Declining Reimbursement and Payment Reform 3. Supply and Implant Spend (Implants, PPI, Devices, Drugs) 4. Utilization Inefficiencies and Unwarranted Clinical Variation 5. Suboptimal Revenue Cycle Performance -------------------------------------- - What are you seeing? - Where do you think healthcare systems should focus with respect to expense reduction? - Would you prioritize expense reduction (direct and controllable) or revenue growth (often slower, more uncertain)? Which has been more impactful on your system’s bottom line?

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Illinois Health and Hospital Association (IHA) President and CEO A.J. Wilhelmi led a panel discussion with healthcare leaders on Monday in Chicago, discussing the coming changes to Medicaid and what it all means for the Illinois Medicaid program. Health News Illinois assembled a panel of experts to discuss this topic, including: Ollie Idowu, CEO, Illinois Primary Health Care Association; Ashley Snavely, CEO, Illinois Health Care Association; Elizabeth Whitehorn, Director, Department of Healthcare and Family Services; Stephanie Altman, Of Counsel and former Director of Healthcare Justice and Senior Director of Policy, Shriver Center on Poverty Law; and Jill Hayden, CEO, Illinois Association of Medicaid Health Plans.

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The migration of care to ASCs and outpatient settings isn't necessarily a new perspective. Healthcare started moving in this direction for years, and the pandemic further accelerated the shift. However, Ascension's $3.9B acquisition of AMSURG is bold for the simple reason that, until now, legacy systems have had every reason to resist this shift. Consolidation and site-of-service arbitrage have allowed non-profits-in-name-only (NPINOs) to leverage market and pricing power to keep high revenue service lines in high cost settings. They've repeatedly resisted site neutrality, price transparency, and true competition. They've doubled down, building large towers and gobbling up physician practices. But that grip may be slipping. Ascension buying AMSURG may indicate that at least one NPINO finally sees the writing on the wall. Time will tell if this is a smart move to stay ahead of the curve and beat large competitors to the punch. Rather than fighting the future, Ascension may be in a stronger position to help shape it. Of course, it may just be a move to keep up with for-profits who already figured out the economic shift. Real innovation will be taking things a step further, building a model from the ground up that's physician-led and patient-first, aligned around outcomes, tech-enabled, and value-based. The future of specialty care isn't about incumbents playing defense. Ascension may be one step ahead of its competitors. The smarter play is to stay 2-3 steps ahead by seeing the ASC/outpatient shift not as an inevitability but as the sea change healthcare needs. https://lnkd.in/epQ972DQ

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In healthcare, we must put the patient at the center of everything we do. Dr. Rich Fogel, Chief Healthcare Outcomes Officer at Ascension, explores this important topic in his recent Fierce Healthcare article—and offers a clear call to action: it's time for a mindset shift. In most industries, consumer experience shapes everything—from strategy and budgeting to design and service delivery. Healthcare has traditionally focused on clinical care alone. But that is changing. At Ascension, we believe delivering high-quality care means more than great medicine. It means listening closely, removing friction, and treating every person with dignity—because our patients are also our consumers. They deserve thoughtful, responsive experiences across every touchpoint. Dr. Fogel shares how we can apply lessons from industries like hospitality, travel, and retail to reimagine healthcare from the inside out. Read the full article here: https://lnkd.in/g-JpgTqb

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It's time for hospitals to campaign. After years of red ink and razor-thin margins, hospitals are regaining their financial footing. This means it is time to elevate strategy--and philanthropy can be a powerful accelerator. Read more in this new American Hospital Association Trustee Insights article that I am honored to have the privilege to write. The document below is shared with the permissive use of the American Hospital Association. #Healthcare #Philanthropy #Campaigns #Leadership

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