Financial Recovery Group

10/15/2026

Value-based care hasn’t caught on with most employers. According to EY US, 40% of employers have none of their medical spending tied to value-based arrangements, and just 3% have more than 31% tied to them.

Employers are shifting toward targeted value strategies — condition-specific programs, bundled episodes, care navigation, alternative sites of care.

Read coverage from Becker's Hospital Review: https://hubs.ly/Q04yXnRy0

10/14/2026

States facing budget shortfalls are turning to private insurers to manage long-term care for some of their sickest members. Not Indiana, Nebraska, or South Carolina.

Here’s why the outsourcing model is spreading and why some worry about members' access to care: https://hubs.ly/Q04yX8cg0

10/13/2026

quality reporting is fragmented. A CMS review of 42 states found 450 reporting requirements tied to about 260 different quality measures, making it hard to compare performance state-to-state.

CMS's response is the Investing in Health Outcomes partnership, a voluntary program in which 37 states have pledged to:

· Focus on health outcomes rather than processes, with an emphasis on prevention, chronic disease management, and behavioral health
· Streamline quality measures without reducing accountability
· Move toward digital quality measurement
· Link financial results to outcomes

Learn more from Fierce Healthcare: https://hubs.ly/Q04yXcj70

10/08/2026

For more than a decade, US health policy has pushed value-based care. But rewards for treatment rob the preventive care effort in improving health outcomes. Milbank Memorial Fund breaks down the VBC structural challenges to effective preventive care.

Read more: https://hubs.ly/Q04yV05M0

For more than a decade, US health policy has been moving toward value-based care, or paying for health outcomes rather than the number of services delivered. And yet, even within many value-based models, preventive care often remains financially difficult to sustain.

10/07/2026

Sachin Jain advocates for a re-emergence of the OG definition of — integrated practice units designed to address particular medical conditions, through which value equals outcomes divided by cost.

Read the Forbes article:

Popular terms like value-based care, innovation, and transformation have gradually lost meaning in US healthcare. How does this happen? And how can we fix it?

10/06/2026

has stalled because it's too often treated as a contract rather than a patient-centered system, says CVS Health's. He says scaling means connecting payers, providers, home care, retail clinics, and pharmacies for members. That focus, plus accurate documentation, can actually improve outcomes and lower costs.

Read more:

Sree Chaguturu, MD, explains why value-based care succeeds when providers, payors, pharmacies and care teams work together to improve outcomes and lower costs.

10/05/2026

The American Hospital Association, the Fed of American Hospitals, and America's Essential Hospitals all urge CMS to stick closer to statute on provider tax thresholds. Their biggest concern: a proposed shift from a prospective, estimate-based compliance approach to a retrospective one, which they say adds administrative burden and could trigger unnecessary refunds and recouped payments.

Read the Fierce Healthcare article: https://hubs.ly/Q04yXnHj0

Provider taxes fund a significant share of state programs, and changes to them can ripple into reimbursement rates, benefits, and access. For a refresher on provider taxes, check out FRG's news brief: https://hubs.ly/Q04yXnPZ0

Hospitals are urging the Trump administration to implement Medicaid provider taxes as outlined in last year’s One Big Beautiful Bill Act “with the least possible disruption,” with calls this week t | Public comment letters from hospital associations asked the administration to stick to the sta...

10/02/2026

Louisiana plans to pay its remaining managed care companies much more next year. The state has proposed new contracts for the four insurers staying in the program, Aetna Better Health, AmeriHealth Caritas, Humana Health Horizons, and Louisiana Healthcare Connections, worth a combined $16.1 billion in 2027. It comes as two other companies exit the state's Medicaid program, shifting up to 580,000 enrollees to new plans.

Learn more:

( Louisiana Illuminator ) — The Louisiana Department of Health has proposed new, larger contract extensions for the four health insurance companies that will remain a part of the Medicaid program. …

10/01/2026

Community health centers serve 52 million Americans, quietly managing chronic conditions like diabetes and heart failure to keep patients out of the ER. But that work is invisible to CMS if it isn't coded correctly.

With HR 1’s Medicaid cuts threatening a major revenue hit (1 in 4 Medicaid patients rely on CHCs for care, and Medicaid generates nearly half of all CHC revenue), Dr. John Torontow says CHCs need to lean into Medicare value-based care, starting with annual wellness visits and accurate attribution, to generate revenue and prepare for the silver tsunami of aging Boomers.

🔗 Read more: https://hubs.ly/Q04w4tJf0

FRG AccuReports continuously monitors cost of care and measure performance in Medicaid and Medicare contracts, highlighting avoidable utilization and gaps in care that erode profit margin. Learn more: https://hubs.ly/Q04w4wBR0

After years working with CHCs, John Torontow, M.D., M.Ph., sees value-based care as more than a payment strategy. He argues it is an opportunity to make the health centers’ often...

09/30/2026

National Women's Health & Fitness Day draws attention to the screenings women members often miss:

- Mammograms and pap smears
- Bone density tests for osteoporosis
- Blood pressure and cholesterol checks
- Thyroid and diabetes testing
- Mental health evaluations

Each gap is a missed chance for providers to catch a problem early. FRG AccuReports helps payers and providers use their data to identify who's due and prioritize outreach.

Learn more: https://hubs.ly/Q04w4LQF0