Don Steigman

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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More sobering news for value-based care. Avalere's recently released analysis of 18 CMMI payment models showed that most lost money -- $6.4 billion over the last decade to be exact. A few community pilots saved around $2B, but the broader picture is less favorable. Maryland's All Payer and Total Cost of Care Models performed the best while one Medicare Advantage and two Primary Care models had the biggest losses. Only 4 of the 18 models demonstrated clear impact on quality. None of the models were endorsed by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) which "provides a forum where those in the field may directly convey both their ideas and their concerns on how to deliver high-value care." The analysis follows a 2023 CBO assessment that found CMMI increased the indirect spending by $5.4 billion over a decade. The simple truth remains: our value problem is primarily an infrastructure problem. VBC can’t be retrofit onto fragmented systems and expected to achieve its intended goals. It's time to rethink what VBC means and how to implement it effectively. Some thoughts: 1. Rethink CMMI’s role. Instead of designing and managing models, fund them. Time-limited grants. Measurable milestones. A formal fast-track for exploratory care models that are truly innovative. 2. Full support for new operators. Privately funded and independently developed platforms can build novel care systems with less bureaucracy and administrative burden. Deeply integrated, specialty-first, tech-enabled. They don’t need risk models to deliver great care; they do it inherently. 3. Reframe the narrative. Maybe it’s time to stop chasing “VBC” as a nebulous, undefinable concept and start building actual advanced care models—ones that optimize for quality, experience, and cost without needing policy tailwinds to function. Not value-based care but the natural progression of a better approach. The dream of high quality, engaging, cost-effective care isn't dead -- but it's probably due for a re-brand. #valuebasedcare #cmmi #innovation

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𝐏𝐚𝐫𝐭 𝐃 𝐍𝐞𝐰𝐬 CMS Released this week —2026 Medicare Part D Bid & Premium Stabilization Details And yes…the 𝐀, 𝐁, 𝐂’𝐬— 𝐚𝐧𝐝 𝐃. 𝐈𝐧 𝐭𝐡𝐞 𝐦𝐞𝐦𝐨: 𝐀 𝐢𝐬 𝐟𝐨𝐫 𝐀𝐯𝐞𝐫𝐚𝐠𝐞 𝐁𝐢𝐝 — 𝐚𝐧𝐝 𝐈𝐭’𝐬 𝐔𝐩 The National Average Monthly Bid (𝐍𝐀𝐌𝐁𝐀) for 2026 is $239.27, a sharp increase from 2025. The Inflation Reduction Act (IRA) continues to reshape the Part D benefit—especially in the catastrophic phase—shifting more financial responsibility to plans. 𝐁 𝐢𝐬 𝐟𝐨𝐫 𝐁𝐚𝐬𝐞 𝐏𝐫𝐞𝐦𝐢𝐮𝐦 — 𝐂𝐚𝐩𝐩𝐞𝐝, 𝐛𝐮𝐭 𝐂𝐥𝐢𝐦𝐛𝐢𝐧𝐠 The Base Beneficiary Premium (BBP) is now $38.99. While the IRA caps annual BBP growth at 6%, rising costs across the system mean both beneficiaries and plans are feeling increased pressure. 𝐂 𝐢𝐬 𝐟𝐨𝐫 𝐂𝐌𝐒 𝐎𝐯𝐞𝐫𝐬𝐢𝐠𝐡𝐭 — 𝐚𝐧𝐝 𝐈𝐭’𝐬 𝐇𝐞𝐫𝐞 For the first time, CMS rejected outlier standalone PDP bids. This is a clear signal that the agency is taking a more active role in ensuring affordability and market stability through stronger bid oversight. Simple explanation-They’re rejecting drug plans that are too expensive. 𝐀𝐧𝐝 𝐍𝐨𝐰 𝐋𝐞𝐭’𝐬 𝐓𝐚𝐥𝐤 𝐀𝐛𝐨𝐮𝐭 𝐃… 𝐟𝐨𝐫 𝐃𝐞𝐦𝐨𝐧𝐬𝐭𝐫𝐚𝐭𝐢𝐨𝐧 The Premium Stabilization Demonstration, originally launched to ease the transition under IRA reforms, is scaling back in 2026: • Premium support drops from $15 to $10/month • The annual cap on premium growth increases from $35 to $50 • Risk corridors — which provided financial protections in 2025 — are being eliminated entirely Participation in 2026 is limited to existing demo participants or new plans aligned with them. What This Could Mean for Health Plans • Greater financial exposure for high-cost members if unmanaged • Increased CMS scrutiny of bids and pricing trends as it should • Potentially leaner plan designs and tighter formularies • Continued contraction of the standalone PDP market These aren’t just numbers—they’re signals. Plans must rethink pricing, benefit strategy, and market positioning to stay competitive in a new Part D environment. 💊💊💊 #MedicarePartD #CMS #IRA #HealthcareStrategy #MedicareAdvantage

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First No Fear CDI podcast Thank you ERNIE DE LOS SANTOS and Catherine Pesek Bird, DO, MBA, CHCQM-PHYADV for hosting the first "No Fear" CDI podcast where we discuss the current state of CDI, the query process, and the opportunity to transform CDI to be a true diving force in helping physicians achieve sustainable durable physician documentation integrity. Physician documentation integrity requires a proactive, preemptive denial avoidance approach to documentation. #nofearscdi, #CDIbetterway, #clinicaljudgment, #medicaldecisionmaking, #betterdocumentation https://lnkd.in/e4Yv7UW8

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PRESS RELEASE - Cutting-Edge Passive Devices and Troupe Health’s Clinical Response Enhance Proactive Care at Innovation Senior Living Portfolio Winter Park, Florida – February 4, 2025 –Innovation Senior Living, Troupe Health and Amba Health and Care are pleased to announce the launch of cutting edge passive monitoring technology for the assisted living middle market. This technology is backed by Troupe Health’s comprehensive clinical response to enhance proactive care and peace of mind for residents at Innovation Senior Living’s communities. Troupe Health has teamed up with Amba Health and Care, a company that uses passive monitoring devices with AI-enabled notifications, to introduce advanced monitoring in assisted living communities. The Amba service will help Troupe and community staff better support residents with proactive care and address changes in conditions, in some cases, before residents even experience symptoms, leading to improved health outcomes and resident satisfaction. "In partnership with Troupe Health and Amba, Innovation Senior Living is proud to integrate advanced technology backed by a robust clinical response system. This collaboration empowers us to provide proactive care and peace of mind for our residents, ensuring their well-being is supported with innovative solutions that align with our commitment to exceptional senior living." Pilar Carvajal, Founder & CEO, Innovation Senior Living.

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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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For many seniors, the transition from hospital to home can be one of the most vulnerable points in their recovery. Without the right support, even small challenges can become major setbacks.   Our team at AdventHealth East Orlando is partnering with the Senior Resource Alliance to launch an innovative transitional care pilot designed specifically for high-risk seniors. The program provides coordinated follow-up, in-home support, and access to community resources within 30 days of discharge.   By connecting medical care with community partnerships, we are helping patients heal safely, regain independence, and stay well where they feel most comfortable, at home.   This is how we are reimagining recovery and advancing whole-person care for every stage of life. AdventHealth Central Florida

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The Commonwealth Fund’s 2025 Scorecard on State Health System Performance shines a spotlight on disparities that persist across communities and highlights the urgent need for targeted strategies to promote fairness in healthcare access and outcomes. This report offers an evaluation of health care access and affordability, prevention and treatment, avoidable hospital use and costs, health outcomes and healthy behaviors, and equity by state.     The report reveals significant variation in progress toward health equity across states and the ongoing challenges in addressing social determinants of health. There is a key focus on emphasizing the importance of robust data to identify and close disparity gaps, while uncovering opportunities to improve care quality and affordability for underserved populations.     The information in this scorecard is a powerful call to collective action and reminder that achieving health equity is a team effort. We can use these insights to drive purposeful efforts that guarantee all individuals have access to affordable, high-quality healthcare—because everyone deserves the opportunity to live a healthy life. By focusing on equity-centered initiatives, health systems can become more resilient, inclusive, and effective in meeting the needs of all communities. https://lnkd.in/gRXbVJ8t 

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