Healthmonix Advisor

The Future of Value-Based Care

A new ten-year experiment called ACCESS is about to test exactly that question — and it could reshape how chronic illness is cared for in America.

Topics: VBC, Value-Based Care, Conference, APG, healthcare, ACCESS

For most of 2024 and 2025, the dominant frame for AI in healthcare was the copilot: AI suggested, a clinician acted. The framing was reassuring. It kept a human in every loop and let institutions defer the hard question of governance, because the AI never did anything a human hadn't already approved.

That framing is breaking down. At the APG Spring Meeting in San Diego this May, 4 organizations — an FQHC, a national VBC enablement company, a Southern California physician group, and UC San Diego Health — described deployments that have moved past copiloting into something more autonomous.

Topics: VBC, Value-Based Care, Conference, AI, APG, healthcare

For roughly a decade, the operating assumption of value-based care has been that you transform outcomes and costs by transforming primary care:

• Attribute the patient to a PCP
• Hand the PCP a panel and a risk arrangement
• Give the care team a gap list
• Let the rest of the system carry on 

That model has produced real wins. It’s also produced a generation of risk-bearing organizations that have squeezed most of what they can out of the levers a primary care physician controls and now find themselves staring at the part of the spend they don’t.

Topics: CMS, VBC, Value-Based Care, Conference, APG

For a decade, the question was whether to take risk. Now it's whether your measurement infrastructure can keep up.

About 1,300 medical group executives gathered at AMGA in Las Vegas last month. Most have already committed capital to value-based care. The strategic debate is over. A new one is starting.

Topics: CMS, VBC, Value-Based Care, MIPS Reporting, Conference, AMGA, AI

 NPPES remains the authoritative source for MIPS, cost attribution, and ACO enrollment today and shouldn't be replaced. The new CMS National Provider Directory (NPD) is a FHIR-based API layer that adds what NPPES can't explicit provider-organization affiliations, near real-time updates, and digital endpoints. For Healthmonix and Prism, the play is to keep NPPES operational while ingesting NPD alongside it, unlocking a "Provider Network Intelligence" layer.

Topics: CMS, NPPES

Jon McNeill, CEO of DVx Ventures and former President of Tesla, opened HIMSS26 with a deceptively simple provocation: automation always comes last. In a conference hall full of people who flew to Las Vegas to talk about AI, his statement landed with force. 

Topics: ACO, Quality Performance Category

HIMSS26 made 1 thing unmistakably clear: the center of gravity in U.S. health IT is shifting to FHIR‑native digital quality measures, interoperable data pipelines, and AI tightly embedded into clinical and administrative workflows.

For anyone working in the CMS quality and value‑based care ecosystem, the “nice‑to‑have” era is over. FHIR and digital quality measures (dQMs) are becoming the operating system.

Topics: ACO, Quality Performance Category

This blog provides a detailed, visual, and measure-level comparison of 3 key CMS programs under the Quality Payment Program (QPP) framework — traditional MIPS, MIPS Value Pathways (MVPs), and the new Ambulatory Specialty Model (ASM) finalized in the 2026 Physician Fee Schedule Final Rule (CMS-1832-F). 

• Traditional MIPS (2017–present): Broad, clinician-driven program allowing flexibility in measure selection but limited comparability across specialties.
   
• MIPS Value Pathways (MVPs, 2023–2026): Transitional structure to align measures by specialty or condition, improving comparability and interoperability. 
  
  
• Ambulatory Specialty Model (ASM, launching 2027): Mandatory, condition-specific model targeting heart failure and low back pain specialists in select CBSAs.

This comparison highlights how CMS is evolving from flexible reporting (MIPS) to  aligned reporting (MVPs) to accountable, outcome-based measurement (ASM), with increasing use of digital quality measures (DQMs), FHIR data exchange, and data validation via DQMs. 

Topics: Value-Based Care

The Centers for Medicare & Medicaid Services (CMS) have released the 2024 Merit-based Incentive Payment System (MIPS) performance feedback and final scores. The 2024 performance year was characterized by stability, consistency, and restrained adjustments. 

Despite modest scoring variations, the 2024 feedback underscores CMS’ strategic redirection toward structured, specialty-aligned models — MIPS Value Pathways (MVPs), the Ambulatory Specialty Model (ASM), and broader CMMI-led innovation frameworks —to drive the next era of value-based reimbursement. 

Topics: Value-Based Care

For years, healthcare providers have navigated the complexities of the Merit-based Incentive Payment System (MIPS). They often find it to be a burdensome, one-size-fits-all compliance requirement that feels more like an administrative chore than a true measure of quality.  

But the landscape of quality reporting is undergoing its most significant evolution yet. The Centers for Medicare & Medicaid Services (CMS) is shifting away from the broad traditional MIPS framework toward a focused, specialty-specific model: MIPS Value Pathways (MVPs). 

Topics: Value-Based Care