Jason Buchanan, M.D., M.S., FAAFP, FACHE

Accurate coding and strong clinical documentation are essential to compliance, provider support and financial sustainability in today’s healthcare landscape. 💡See how CHRISTUS Health tackled HCC risk adjustment and CDI workflow challenges while staying true to clinical integrity and compliance. What you’ll learn: • Key barriers to HCC risk adjustment and CDI integration • How CodingCare improved documentation accuracy and provider adoption • Why CodingGuide completed the HCC workflow with retrospective insights • Lessons learned to strengthen compliance and provider engagement View this on-demand webinar to learn how CHRISTUS Health achieved meaningful results: https://lnkd.in/eZ5-DAyd

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Insurers, Hospitals Push Back Against CMS Proposal To Bring Non-Network Plans To ACA Exchanges Fierce Healthcare reports, “Insurers and hospitals have come together to rebuke” an Administration “proposal to roll back limits of plan designs that may be listed on the Affordable Care Act’s (ACA’s) exchanges.” The CMS last month “included in its Notice of Benefit and Payment Parameters for 2027 Proposed Rule a plan to allow some non-network plans to obtain qualified health plan (QHP) status.” In response, “groups representing health plans (AHIP, Association for Community Affiliated Plans and Alliance of Community Health Plans) as well as hospitals (Federation of American Hospitals and America’s Essential Hospitals) crossed the aisle to submit a joint comment letter to CMS calling on the administration to rethink its approach.” In the letter, they explained their top concern is that people shopping for coverage on the exchanges “won’t be able to grasp the differences between network and non-network plans, potentially exposing them to higher-than-expected out-of-pocket costs.” #cms #non-networkplans #ahip

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CMS just proposed a 0.09% Medicare Advantage rate increase for 2027. Wall Street expected 4-6%. Humana dropped 13%. UnitedHealth fell 9%. CVS down 9%. The era of MA as a margin expansion vehicle is ending. CMS is signaling that plans need to deliver value to members, not just shareholders. If plans respond by cutting benefits or exiting markets, seniors lose. If plans respond by finally fixing operational inefficiencies, everyone wins. The next few months will reveal which path the industry chooses. Insurers have been running the same playbook for years. Negotiate rates, manage utilization, expand membership. That playbook assumed steady rate increases would cover rising costs but the math breaks with rates essentially flat. The plans that don't adapt will either exit MA or get acquired by those who did. Last year's 5.06% increase masked structural problems. This year's 0.09% exposes them. Health plan leaders watching this should be asking: Are we built to deliver value at these margins, or were we built for a different era?

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The End of VBID: The Signal Behind the Noise in Medicare Advantage When CMS confirmed it would sunset the Medicare Advantage Value-Based Insurance Design (VBID) Model at the end of 2025, a lot of the initial reaction I heard was anxiety. My reaction was different: this isn’t the end of value-based care—it’s the end of the pilot phase. For those of us building and operating provider-led risk platforms—groups like Agilon Health, Arkos Health, Privia Health, Wellvana, P3 Health Partners, ChenMed, VillageMD, Castell, and others—VBID was never the core engine. It was a plan tool, not a provider model. It helped MA plans layer on supplemental benefits and flex design, but it didn’t create the operating discipline needed to actually manage total cost of care. The real story in 2026 is margin compression. MA plans are getting squeezed by rising MLRs, evolving risk adjustment (v28), and STARs volatility, and they’re realizing you can’t “spreadsheet” your way to savings. You need partners who can operate: - Manage post-acute in real time - Intervene on high-risk seniors at home - Document accurately and compliantly under v28 That’s why there’s a clear flight to quality. Plans are moving closer to risk-bearing entities that consistently deliver outcomes—and away from loosely managed, contracting-only relationships. With VBID gone, the “perk” seniors feel most isn’t an extra benefit card. It’s the PCP and care team that keep them out of the hospital, coordinate their meds, and actually know their story. To me, that’s the real message of this moment: - The noise is about the model. - The signal is about the mission. VBID may be ending, but for serious value-based operators, this is when the work gets even more meaningful. Let’s keep building. #ValueBasedCare #MedicareAdvantage #HealthcareInnovation #ArkosHealth #AgilonHealth #PriviaHealth #Wellvana #P3HealthPartners #ChenMed #VillageMD #CastellHealth #CMS #VBID #RiskBearingProviders #PopulationHealth

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As many folks head to Dallas this week for the Healthcare Financial Management Association (HFMA) Revenue Cycle Conference, I’m excited to share news that marks another step forward as we continue the investment in Knowtion Health and its future serving health systems across the country get paid appropriately for the services they provide. We’ve completed the acquisition of revly, founded and led by Bennett Holden, expanding our claim routing service offering. Our combined offering is now the most comprehensive (PB + HB) and EMR agnostic solution in the market. We are committed to intentionally adding specific verticals to help revenue cycle leaders solve specific complex problems coupled with best in KLAS Research customer service. On behalf of all of my teammates, we couldn’t be more excited about the future of Knowtion Health! You can read more about the announcement here-> https://lnkd.in/guwYbhCb

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