Gary C. Cooper

Independent physicians are driving better care and lower costs — and the data proves it. A recent Avalere Health study found that Medicare beneficiaries treated by independent physicians at Duly Health and Care had nearly $7,800 lower annual expenditures compared to those treated by hospital-affiliated providers. Key takeaways: ✅ 25% lower average annual Medicare spending across five specialties ✅ 15% fewer inpatient days and 12% fewer ED visits ✅ More mammograms and procedures done outside costly hospital settings ✅ Coordinated care = even greater savings and better outcomes This data underscores the value of preserving independent practice — for patients, payers, and the broader healthcare system. At Unified Women's Healthcare, we remain deeply committed to supporting independent women’s health providers and ensuring access to personalized, efficient care. The study is linked in the comments if you'd like to read more!

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Big News from CMS: A major shake-up in Medicare Advantage oversight. Last night, CMS announced a bold and aggressive new audit strategy: -         Every Medicare Advantage (MA) plan will now be audited every year -         Larger claim sample sizes will be reviewed -         Resources are being deployed to clear the audit backlog from 2018– 2024 https://lnkd.in/etxdSKrG Now is the time for providers, coders, and billing partners to tighten documentation, review risk coding accuracy, and be audit-ready. If you work with MA plans — this isn’t a warning, it’s a new normal. #CMS #MedicareAdvantage #RiskAdjustment #MedicalBilling #HealthcareCompliance #ProviderEducation #ValueBasedCare #WCHCredentialing 

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AEP - Unlocking the value of Medicare Advantage   For many of us, preparations for Medicare’s Annual Enrollment Period (AEP) have been underway for some time. With the growing emphasis on Medicare Advantage, it is more important than ever to clearly demonstrate the value and quality of care we provide to those we serve.   At Alignment Health Plan, our commitment to excellence extends beyond member care to supporting our broker community. Broker partners are essential in helping members—both new and existing—understand our extensive plan benefits, from prescription drug coverage to vision, dental, hearing, wellness programs, and supplemental benefits. By fostering strong relationships and equipping brokers with the right knowledge and tools, we empower them to confidently guide prospective and existing members.   For over a decade, Alignment Health’s innovative technology, high-touch care model, and diverse provider networks have been built around a single mission: putting seniors at the heart of everything we do and treating each member like family. Our growth, consistently strong Star ratings, broad plan offerings, and—most importantly—positive member feedback all reflect our commitment to compassionate, accessible, and around-the-clock access to care.   By focusing on one simple principle – Put the Senior First – we can unlock the value of Medicare Advantage and raise the standard for what Medicare Advantage can and should be.   #AlignmentHealthPlan #AlignmentHealth #Duals #HealthcareLeadership #AdvocacyMatters #ValueBasedCare #FreedomOfChoice #LeadershipInAction #MedicareAdvantage #HealthPolicy

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How can employers, PBMs, and health plans provide support to members on GLP-1s that they’ll both take advantage of and benefit from? Omada Health’s Enhanced GLP-1 Care Track (ECT) provides personalized support to members on their GLP-1 journey–and the early outcomes are very exciting. According to recent insights from our ANSWERS initiative, members who opted into this program saw: ⚡Higher engagement ⚡Increased self-efficacy ⚡Early indicators of healthy weight loss Learn more about the success members are seeing in a recent whitepaper: https://lnkd.in/gGfTRmxH

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𝗖𝗩𝗦 𝗘𝘅𝗶𝘁𝘀 𝗔𝗖𝗢 𝗥𝗘𝗔𝗖𝗛, 𝗦𝗲𝗹𝗹𝘀 𝗠𝗦𝗦𝗣 𝗕𝘂𝘀𝗶𝗻𝗲𝘀𝘀 𝘁𝗼 𝗪𝗲𝗹𝗹𝘃𝗮𝗻𝗮 𝗔𝗺𝗶𝗱 𝗖𝗼𝘀𝘁-𝗖𝘂𝘁𝘁𝗶𝗻𝗴 𝗘𝗳𝗳𝗼𝗿𝘁𝘀 CVS Health is scaling back its value-based care operations, shutting down its ACO REACH program and selling its Medicare Shared Savings Program (MSSP) business to Wellvana. The move, part of CVS’s broader cost-cutting strategy, affects 183 employees and follows a series of layoffs and restructuring efforts. MSSP ACOs saved Medicare $2.1B in 2023, but CVS has struggled with rising Medicare Advantage costs and regulatory pressures. Despite the exit, CVS remains engaged in value-based care through Oak Street Health and Aetna’s ACO contracts. The decision aligns with other insurers like Clover Health and Alignment Healthcare, which have also distanced themselves from the program due to financial challenges.

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If you want to own a private jet as a health benefits consultant, just follow three rules: (1) relentlessly learn all the most innovative, transformative strategies in the industry, (2) teach these strategies to all the employers and prospects with whom you interact, and (3) never, under any circumstance, implement or allow your employers to implement any of these strategies. Knowing about innovation is sexy. Talking about transformative approaches at cocktail parties is provocative. It’s a great way to get speaking engagements. Nevertheless—implementing innovation can be messy and unpredictable. Even when it ends well, it can be a rough road and cause a few scars along the way. This is dangerous for a consulting relationship, but necessary to improve the industry. Let’s all give some grace to the consultants who break Rule #3, private jets are overrated.

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Are they Finally Coming? Leaders have called this the single thing needed to significantly improve MRF compliance, completeness, and quality. 👇   Transparency in Coverage Fines 💰   So far there have been 25 fines issued to hospitals, but 0 fines issued to Health Plans or Plan Sponsors. It's been reported that the hospital transparency data improved significantly, almost overnight, when fines started to be issued.   Some possible reasons why health plans and plans sponsors have been spared… 1️⃣ Fines are Ridiculously Huge - Up to $100 per day, per affected member (enrollee), for each day of non-compliance. For 1,000 covered lives this would be $100,000 per day and $36.5Mil per year. Not many plan sponsors could pay this fine and continue their business.   2️⃣ Lobbyists - there has been significant pushback from lobbyist representing health plans. Their efforts have led regulators to delay enforcement and given more time to comply.   3️⃣ Lax Enforcement - lack of resources and priority to take action has likely played a part. MRF files are massive and require significant computer resources and subject matter expertise to load and analyze. Being in a position to assess these files and identify gaps would require a significant investment of time and money. This would only happen if it's made a priority.   What Changed?   💡On February 25, 2025, the White House issued an executive order directing federal agencies to rapidly implement and strictly enforce health care price transparency regulations.   This order requires:   🔹Disclosure of the actual prices of items and services, not just estimates.   🔹Updated guidance and proposed regulations to standardize pricing information so it is easily comparable across hospitals and health plans.   🔹New or revised enforcement policies to ensure compliance with the transparent reporting of complete, accurate, and meaningful data.   Agencies have 90 days from the order to issue updated enforcement guidance, which is expected to directly impact how and when fines are assessed.   What does this mean?    💥More fines are likely coming… ❓Will they include Health Plans and Plan Sponsors? If they do, we can expect TiC MRF data quality and completeness to improve significantly. 🚀

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On behalf of Clearsense, Inc, we are excited to have Summa Health join our expanding client portfolio! With the growing trend of PE-backed acquisitions (such as Summa's impending General Catalyst deal) and all other M&A ramping up across the provider sector, we are pleased to be a material part of accelerating the value of cost reduction, cyber risk mitigation and revitalizing data for driving healthcare outcomes. Thank you Elbridge Locklear, MBA, CHCIO, CDH-E for our new partnership! "By leveraging Clearsense's technology expertise and innovative solutions, we can rapidly provide access to complete patient data, supporting better care coordination and advancing population health management. This collaboration marks a significant step forward in optimizing data enablement and is key to achieving our goals of enhanced clinical outcomes and greater operational efficiency," said Elbridge Locklear, Chief Information Officer at Summa Health.

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𝐓𝐇𝐄 “𝐁𝐈𝐆 𝐁𝐄𝐀𝐔𝐓𝐈𝐅𝐔𝐋 𝐁𝐈𝐋𝐋”: 𝐀 𝐓𝐇𝐑𝐄𝐀𝐓 𝐓𝐎 𝐇𝐄𝐀𝐋𝐓𝐇𝐂𝐀𝐑𝐄 𝐀𝐂𝐂𝐄𝐒𝐒 The proposed Budget Reconciliation Bill—often called the One Big, Beautiful Bill—has sparked urgent conversations about the future of healthcare in the U.S., especially in rural states like #WestVirginia. Funding cuts to #Medicaid, facility closures, and widespread loss of coverage are just the beginning of a healthcare landscape that will struggle to meet growing demand. Even in the face of these looming changes and the uncertainty they bring, safety-net providers have a long tradition of resilience. While significant funding reductions and the threat of hospital closures will profoundly impact patients nationwide—and particularly in West Virginia—there are proactive steps providers can take to sustain care. Strengthening care coordination and expanding telehealth services will be crucial for helping patients maintain access despite coverage gaps and rural barriers. Pursuing alternative payment models and optimizing operations can stabilize revenue and make limited resources go further. At the same time, partnering with community organizations extends support beyond facility walls and strengthens the safety net. Despite these challenges, the commitment to deliver care remains unwavering. #FQHCs, rural hospitals, and other #SafetyNetProviders have weathered funding cliffs and policy shifts before—and will continue finding ways to meet the needs of the communities they serve, no matter the policy landscape. #RuralHealth #HealthEquity #HealthcareAccess

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For all the talk about payment models and reimbursement reform service, one fact gets overlooked -- healthcare demand is growing faster than supply. In fact, while demand is expected to explode, supply may be shrinking (doctors aging out of practice, retiring early, or burning out). The unfortunate truth is that the extensive time, money, and resources being focused on the downstream may not be enough, even if we achieve the most efficient, cost-effective, waste-free system. Healthcare spending will soon crest $5 trillion (if it hasn't already). At an expected 5.6% annual growth rate, healthcare spending outstrips GDP growth (4.3%). Based on those numbers, it would take $65 billion of yearly savings just to bring healthcare spending in line with GDP. Thus far, CMS/CMMI efforts to stem the tide haven't made much of a dent. The most successful programs have saved on the order of $2-3 billion. Impressive, but a mere 0.04-0.06% of the $5 trillion problem. Other programs have produced more modest savings -- tens to hundreds of millions. Savings don't take into account the cost of administering these programs, an issue that's less well understood and frequently omitted in calculations and discussions. The CBO recently estimated that, taken in whole, CMMI spent $5.4 billion more than it saved in its first decade. Less than ideal. What's the takeaway? First, we have to move more efforts upstream. Without stemming demand, no amount of supply-side efficiency is going to be sufficient. This means more focus on prevention, wellness, patient experience, and patient engagement. (Ounce of prevention > pound of cure). We also have to understand that health does not exist outside of broader societal factors. Expecting the healthcare system alone to fix these (or deal with their consequences) is a recipe for failure. Next, we have to figure out a better way to really integrate prevention, wellness, and holistic health (the core of primary care) with downstream treatment (highly effective specialty care). Current integration efforts create too much of a tug-of-war. They incentivize avoidance and rely on spurious metrics rather than ensuring the high value care and high yield clinical pathways. The more I delve into these topics (including my last couple of Surgeon's Record posts and upcoming webinar with Daniel J. Durand), the more I think our current approach needs significant tweaking. Right now, efforts are nascent. But the thought exercise is slowly leading to action. Prevention, wellness, and health optimization--when approached thoughtfully and as part of a larger strategy--can be more than buzzwords for the worried well. #medicine #healthcare #health #healthcareinnovation

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𝗕𝘂𝗶𝗹𝗱𝗶𝗻𝗴 𝗕𝗿𝗶𝗱𝗴𝗲𝘀: 𝗘𝗻𝗵𝗮𝗻𝗰𝗶𝗻𝗴 𝗧𝗲𝗮𝗺 𝗠𝗼𝗿𝗮𝗹𝗲 𝗮𝗻𝗱 𝗣𝗿𝗼𝗱𝘂𝗰𝘁𝗶𝘃𝗶𝘁𝘆 𝘁𝗵𝗿𝗼𝘂𝗴𝗵 𝗗𝗶𝘃𝗲𝗿𝘀𝗶𝘁𝘆 𝗟𝗲𝗮𝗱𝗲𝗿𝘀𝗵𝗶𝗽 🌉 Are you navigating the challenges of leading a diverse team within your healthcare institution? It’s a tough but crucial task that significantly affects team morale and productivity. If not managed well, it can impact patient care and tarnish your institution's reputation. Here’s a proactive plan to enhance team leadership in a healthcare setting: 📌 Leadership Coaching: Boost leaders’ emotional intelligence and communication skills specifically tailored to healthcare environments. 📌 Performance Feedback Systems: Implement 360-degree evaluations to gather comprehensive insights that reflect the diverse healthcare setting. 📌 Employee Resource Groups: Support groups that address the unique challenges and needs of diverse healthcare teams. 📌 Cultural Competency Resources: Provide access to resources and training that enhance understanding across different cultures within the healthcare sector. 📌 Diversity & Inclusion Training: Promote inclusivity and address unconscious biases that could affect patient care and team dynamics. Implementing these strategies can lead to improved morale, increased productivity, and a more inclusive atmosphere in your healthcare institution. ✨ Have you faced challenges with diversity in your healthcare team? What strategies have worked for you? Share your insights below! ➖➖➖ Over the last 25+ years as an MD with an MBA and MPH, I have worked with 3 Multi-Million dollar Hospital organizations serving as VPMA and CMO saving millions of dollars and improving quality. I went on to serve as Chief Physician Executive for BDO USA, the fifth-largest professional services firm in the United States. The key to my clients' success has been my proprietary ACCESS Methodology. Assess Coach Consult Execute Strategize Simplify Today, I run my own organization helping hospital executives solve their “Burning Issues”. For a limited time, get my newest ebook for free: "Caught in the Crossfire: The 5 Executive Errors That Ignite Corporate Crises in Hospitals”. Quickly learn 5 critical hospital mistakes and how to fix them. ***** 👉 Type “PDF” in the COMMENTS, and I will send you a FREE PDF copy. #diversityleadership #teamproductivity #enhancingmorale #buildingbridges #humanresources #healthcare

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Tracking senior living metrics is not just about numbers and charts. It's about creating a deeper understanding and connection to the people you serve. It’s about:  - Understanding the unique needs of your residents  - Empowering staff with actionable insights to deliver better care  - Anticipating challenges before they arise, not reacting to them  - Building a culture rooted in care, accountability, and continuous improvement When you start focusing on senior living KPIs, you unlock clarity in your operations. But more importantly, it’s about creating a sense of purpose—knowing that every metric tracked is ultimately improving lives, not just systems. These insights lead to happier residents, more engaged staff, and a thriving community. Of course, occupancy rates, revenue targets, average length of stay (ALOS), and revenue per occupied unit (RevPOR) matter.  But, the true impact comes from measuring something even more important: the happiness and satisfaction of your residents. When people start recognizing your facility for its compassion, care, and commitment to excellence that’s when you know the metrics are working. What metrics are you tracking to drive your growth this year?

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Black Book™ has developed 18 enhanced KPIs to evaluate client satisfaction, ROI & overall experience with HIT consulting firms. These KPIs offer a comprehensive framework for assessing how well consultants align with client objectives, deliver measurable outcomes, and uphold ethical practices. Tailored to the unique complexities of healthcare organizations, these KPIs empower stakeholders to assess consulting engagements and determine their long-term value. https://lnkd.in/eCm5dith #HIMSS #theviveevent #consultants #BlackBook

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Misleading Marketing Practices in Medicare Advantage "In recent years, concerns about aggressive and deceptive marketing practices in Medicare Advantage have become more pressing. These concerns have focused on agents and brokers used by Medicare Advantage plans who target and mislead seniors, at times enrolling them in plans without their knowledge or directing them to plans that substantially increase their out-of-pocket costs. This study will examine Medicare Advantage marketing practices and the harms they cause to individuals. It will focus on the complaints individuals reported to CMS from 2020 to 2024 about Medicare Advantage marketing practices. We will also look at the actions taken by agents and brokers that led to the complaints and the incentive structures that encourage brokers to change individuals' enrollments."

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