--- title: Blog – The Healthmonix Advisor | CMS description: CMS | The Healthmonix Advisor - A Blog for healthcare professionals, health systems, and hospitals --- ![logo-light](https://blog.healthmonix.com/hubfs/logo-light.png "logo-light") - [Who we help](https://healthmonix.com/who-we-help/) - [Overview](https://healthmonix.com/who-we-help/) - [ACOs](https://healthmonix.com/acos/) - [Health systems](https://healthmonix.com/health-system/) - [Healthcare technology](https://healthmonix.com/healthcare-technology/) - [Physician practices](https://healthmonix.com/physician-practice/) - [Health system VPs](https://healthmonix.com/health-system-vice-presidents/) - [Chief financial officers](https://healthmonix.com/chief-financial-officers/) - [Chief medical officers](https://healthmonix.com/chief-medical-officers/) - [Chief quality officers](https://healthmonix.com/chief-quality-officers/) - [ACO executive directors](https://healthmonix.com/aco-executive-directors/) - [Solutions](https://healthmonix.com/prism/) - [MIPSpro](https://healthmonix.com/product/mips-pro/) - [Cost](https://healthmonix.com/product/cost/) - [ACO Impact](https://healthmonix.com/product/aco-impact/) - [Analytics](https://healthmonix.com/product/analytics/) - [Ambulatory Specialty Model](https://healthmonix.com/ambulatory-specialty-model-asm/) - [TEAM](https://healthmonix.com/team-program/) - [HealthConnect](https://healthmonix.com/health-connect/) - [Data integration](https://healthmonix.com/dataintegration/) - [Consulting](https://healthmonix.com/consulting-services/) - [Score optimization](https://healthmonix.com/score-optimization/) - [Patient matching](https://healthmonix.com/patient-deduplication-and-matching/) - [Outcomes](https://healthmonix.com/outcomes/) - [Company](https://healthmonix.com/company/) - [Our story](https://healthmonix.com/company/) - [Team](https://healthmonix.com/team/) - [Careers](https://healthmonix.com/healthmonix-careers/) - [Resources](https://healthmonix.com/resources/) - [Help and support](https://healthmonix.com/customer-support/) - [Healthmonix Advisor](https://blog.healthmonix.com/) - [Webinars](https://healthmonix.com/our-webinars/) - [Educational resources](https://healthmonix.com/mips-education/) - [Help and support](https://healthmonix.com/customer-support/) - [Contact us](https://healthmonix.com/contact-us/) - [Measures](https://healthmonix.com/mips-measures/) - [Quality](https://healthmonix.com/mips-measures/mips-quality-measures/) - [CMS specialty sets](https://healthmonix.com/cms-mips-specialty-measure-sets/) - [Promoting Interoperability](https://healthmonix.com/mips-measures/mips-promoting-interoperability-measures/) - [Improvement Activities](https://healthmonix.com/mips-measures/mips-improvement-activities/) - [Cost](https://healthmonix.com/mips-measures/mips-cost-performance-category/) - [Log in](https://healthmonix.com/login/) # Healthmonix Advisor ## [The 80% problem: Why value-based care will be won in specialty](https://blog.healthmonix.com/the-80-percent-problem-why-value-based-care-will-be-won-in-specialty) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on June 1, 2026 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/healthmonix_blog_thumbnail.png)](https://blog.healthmonix.com/the-80-percent-problem-why-value-based-care-will-be-won-in-specialty) 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. [Read More](https://blog.healthmonix.com/the-80-percent-problem-why-value-based-care-will-be-won-in-specialty) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/the-80-percent-problem-why-value-based-care-will-be-won-in-specialty#comments-listing) Topics: [CMS](https://blog.healthmonix.com/topic/cms), [VBC](https://blog.healthmonix.com/topic/vbc), [Value-Based Care](https://blog.healthmonix.com/topic/value-based-care), [Conference](https://blog.healthmonix.com/topic/conference), [APG](https://blog.healthmonix.com/topic/apg) ## [The VBC Bottleneck Has Changed](https://blog.healthmonix.com/the-vbc-bottleneck-has-changed) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on May 19, 2026 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/Screenshot%202026-05-18%20125628.png)](https://blog.healthmonix.com/the-vbc-bottleneck-has-changed) 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. [Read More](https://blog.healthmonix.com/the-vbc-bottleneck-has-changed) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/the-vbc-bottleneck-has-changed#comments-listing) Topics: [CMS](https://blog.healthmonix.com/topic/cms), [VBC](https://blog.healthmonix.com/topic/vbc), [Value-Based Care](https://blog.healthmonix.com/topic/value-based-care), [MIPS Reporting](https://blog.healthmonix.com/topic/mips-reporting), [Conference](https://blog.healthmonix.com/topic/conference), [AMGA](https://blog.healthmonix.com/topic/amga), [AI](https://blog.healthmonix.com/topic/ai) ## [NPPES vs. CMS National Provider Directory](https://blog.healthmonix.com/nppes-vs.-cms-national-provider-directory) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on May 14, 2026 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/nppes_vs_npd_hero.jpg)](https://blog.healthmonix.com/nppes-vs.-cms-national-provider-directory)  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. [Read More](https://blog.healthmonix.com/nppes-vs.-cms-national-provider-directory) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/nppes-vs.-cms-national-provider-directory#comments-listing) Topics: [CMS](https://blog.healthmonix.com/topic/cms), [NPPES](https://blog.healthmonix.com/topic/nppes) ## [Key Takeaways from the NAACOS 2021 Fall Conference](https://blog.healthmonix.com/key-takeaways-from-the-naacos-2021-fall-conference) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on October 15, 2021 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/Conference.jpg)](https://blog.healthmonix.com/key-takeaways-from-the-naacos-2021-fall-conference) The [NAACOS](https://www.naacos.com/) Fall 2021 Conference was the first live meeting that the [Healthmonix team](https://healthmonix.com/leadership-team/) attended since HIMSS 2020 was cancelled in March of that year. It was certainly reinvigorating to meet in person, discuss the state of payment models, and hear from CMS regarding their vision. [Read More](https://blog.healthmonix.com/key-takeaways-from-the-naacos-2021-fall-conference) 2 Comments [Click here to read/write comments](https://blog.healthmonix.com/key-takeaways-from-the-naacos-2021-fall-conference#comments-listing) Topics: [CMS](https://blog.healthmonix.com/topic/cms), [ACO](https://blog.healthmonix.com/topic/aco), [Industry insights](https://blog.healthmonix.com/topic/industry-insights), [2021 PFS Proposed Rule](https://blog.healthmonix.com/topic/2021-pfs-proposed-rule) ## [MVPs - Will they replace 'traditional' MIPS?](https://blog.healthmonix.com/mvps-will-they-replace-traditional-mips) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on January 28, 2021 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/Blog_Graphic_1.26.jpg)](https://blog.healthmonix.com/mvps-will-they-replace-traditional-mips) There has been much talk around MVPs in the CMS quality reporting arena. MVP means [MIPS Value Pathway](https://qpp.cms.gov/mips/mips-value-pathways), and it’s a reporting framework that CMS is communicating as (a) the next evolution of MIPS and (b) a transition tool for getting to other alternative payment modules. As CMS continues to define and refine their vision of the MVPs, they have started to call the current framework '[traditional MIPS](https://qpp.cms.gov/mips/traditional-mips)' to prepare for the inclusion of the MVP option. You’ll see this when you visit the QPP site. That said, how can MVPs affect MIPS? [Read More](https://blog.healthmonix.com/mvps-will-they-replace-traditional-mips) 1 Comment [Click here to read/write comments](https://blog.healthmonix.com/mvps-will-they-replace-traditional-mips#comments-listing) Topics: [MACRA & MIPS](https://blog.healthmonix.com/topic/macra-mips), [CMS](https://blog.healthmonix.com/topic/cms), [2021 PFS Proposed Rule](https://blog.healthmonix.com/topic/2021-pfs-proposed-rule), [MIPS Value Pathways](https://blog.healthmonix.com/topic/mips-value-pathways) ## [MIPS 2021 Incentives and Penalties | How Can You Prepare?](https://blog.healthmonix.com/mips-2021-incentives-and-penalties-we-are-entering-prime-time) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on January 14, 2021 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/Blog_Image_Carrot.jpg)](https://blog.healthmonix.com/mips-2021-incentives-and-penalties-we-are-entering-prime-time) For years, we’ve heard that the [Merit-based Incentive Payment System](https://qpp.cms.gov/mips/traditional-mips) (MIPS) will provide a noticeable incentive for participants in this Medicare FFS program. And for years, there have been reasons why that has not occurred. First, CMS wanted to ‘start slow’ with the MIPS program in 2017 and 2018, so the caps on penalties and incentives were small. Then the potential penalties and incentives were raised, but the threshold for qualifying for an incentive remained low. This, coupled with the program’s budget neutrality meant there was not much revenue to distribute to high performers. Then [COVID-19](https://blog.healthmonix.com/2021-final-rule-new-programs-higher-standards-covid-19) negated much of the program for the last two years. So here we are, in year five, and we see that the program, for the first time, will have a significant downside and upside potential. [Read More](https://blog.healthmonix.com/mips-2021-incentives-and-penalties-we-are-entering-prime-time) 6 Comments [Click here to read/write comments](https://blog.healthmonix.com/mips-2021-incentives-and-penalties-we-are-entering-prime-time#comments-listing) Topics: [MACRA & MIPS](https://blog.healthmonix.com/topic/macra-mips), [CMS](https://blog.healthmonix.com/topic/cms), [APMs](https://blog.healthmonix.com/topic/apms), [Cost Performance Category](https://blog.healthmonix.com/topic/cost-performance-category), [2021 PFS Final Rule](https://blog.healthmonix.com/topic/2021-pfs-final-rule) ## [Key Takeaways on the 2021 Proposed Rule](https://blog.healthmonix.com/key-takeaways-on-the-2021-proposed-rule) Posted by [Mike Lewis](https://blog.healthmonix.com/author/mike-lewis) on August 14, 2020 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/HMX_SALESPPT_BARGRAPH-01.jpg)](https://blog.healthmonix.com/key-takeaways-on-the-2021-proposed-rule) The 2021 Proposed Rule was released last week, and there are some potential changes that you should keep your eye on. Scouring through the entire release, it’s apparent that the Centers for Medicare & Medicaid Services (CMS) kept to their two main objectives: 1. Minimize changes to reduce the burden on providers digging out of COVID-19 2. Keep the momentum of the Quality Payment program moving forward [Read More](https://blog.healthmonix.com/key-takeaways-on-the-2021-proposed-rule) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/key-takeaways-on-the-2021-proposed-rule#comments-listing) Topics: [MACRA & MIPS](https://blog.healthmonix.com/topic/macra-mips), [CMS](https://blog.healthmonix.com/topic/cms), [Policy](https://blog.healthmonix.com/topic/policy), [2021 PFS Proposed Rule](https://blog.healthmonix.com/topic/2021-pfs-proposed-rule) ## [2020 MIPS Reporting Period – Did it Get Cut in Half?](https://blog.healthmonix.com/2020-mips-reporting-period-did-it-get-cut-in-half) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on July 30, 2020 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/Time%20running%20out%20-%20medium.jpg)](https://blog.healthmonix.com/2020-mips-reporting-period-did-it-get-cut-in-half) The quick answer is NO! There has been quite a bit of discussion, and some press, about the reporting period for MIPS for 2020. I have seen a few articles saying that no data reflecting services provided January 1, 2020 through June 30, 2020 will be used in the Center for Medicare & Medicaid Services (CMS’s) calculations for the Medicare quality reporting and value-based purchasing programs. However, if you read the [Quality Payment Program – COVID-19 Response](https://qpp-cm-prod-content.s3.amazonaws.com/uploads/966/QPP%20COVID-19%20Response%20Fact%20Sheet.pdf), Updated 6/24/2020, there is no mention of an all-inclusive change to the reporting period. [Read More](https://blog.healthmonix.com/2020-mips-reporting-period-did-it-get-cut-in-half) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/2020-mips-reporting-period-did-it-get-cut-in-half#comments-listing) Topics: [MACRA & MIPS](https://blog.healthmonix.com/topic/macra-mips), [CMS](https://blog.healthmonix.com/topic/cms), [Industry insights](https://blog.healthmonix.com/topic/industry-insights) ## [No CMS Updates on COVID-19's Impact on MIPS reporting - What it means](https://blog.healthmonix.com/no-cms-updates-on-covid-19-impact-on-mips-reporting-what-it-means) Posted by [Robert Stoudt](https://blog.healthmonix.com/author/robert-stoudt) on June 18, 2020 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/MIPS%20stock%20photo.jpg)](https://blog.healthmonix.com/no-cms-updates-on-covid-19-impact-on-mips-reporting-what-it-means) In the last couple of weeks, some major changes have been made to the [immediate future of Value-Based Care payment models](https://www.cms.gov/files/document/covid-innovation-model-flexibilities.pdf). Some of these updates include: - The extension of the Oncology Care Model (OCM) until June of 2022. The Centers for Medicare & Medicaid Services (CMS) is also giving practices the ability to abdicate downside and upside risk performance during the COVID-19 outbreak. - The delay of starting the new Direct Contracting model to April 1st, 2021. - The extension of the Next-Gen ACO model until December 2021. - The option for participating entities in the Bundled Payments for Care Improvement Advanced (BPCI) payment model  to eliminate upside or downside risk. - The removal of COVID-19 episodes of care for certain Medicare ACO models. [Read More](https://blog.healthmonix.com/no-cms-updates-on-covid-19-impact-on-mips-reporting-what-it-means) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/no-cms-updates-on-covid-19-impact-on-mips-reporting-what-it-means#comments-listing) Topics: [MACRA & MIPS](https://blog.healthmonix.com/topic/macra-mips), [CMS](https://blog.healthmonix.com/topic/cms), [COVID-19](https://blog.healthmonix.com/topic/covid-19) ## [CMS relaxes more rules around telehealth, allowing healthcare across state lines](https://blog.healthmonix.com/cms-relaxes-more-rules-around-telehealth-allowing-healthcare-across-state-lines) Posted by [Lauren Patrick](https://blog.healthmonix.com/author/lauren-patrick) on April 14, 2020 - [Tweet](https://twitter.com/share) [![](https://blog.healthmonix.com/hubfs/shutterstock_1228571512%20-%20telehealth%20small.jpg)](https://blog.healthmonix.com/cms-relaxes-more-rules-around-telehealth-allowing-healthcare-across-state-lines) The Centers for Medicare & Medicaid Services (CMS) continues to relax regulations to enable hospitals, clinics and other providers to boost their front-line medical staff during the COVID-19  pandemic. This pandemic has created an urgency for expansion of the use of virtual healthcare to reduce the risk of spreading the virus. It has also created a need to relax practice restrictions and allow more flexible care practices to meet the needs of patients. [Read More](https://blog.healthmonix.com/cms-relaxes-more-rules-around-telehealth-allowing-healthcare-across-state-lines) 0 Comments [Click here to read/write comments](https://blog.healthmonix.com/cms-relaxes-more-rules-around-telehealth-allowing-healthcare-across-state-lines#comments-listing) Topics: [CMS](https://blog.healthmonix.com/topic/cms), [Interoperability](https://blog.healthmonix.com/topic/interoperability), [Industry insights](https://blog.healthmonix.com/topic/industry-insights), [Policy](https://blog.healthmonix.com/topic/policy), [Health IT](https://blog.healthmonix.com/topic/health-it), [VBC](https://blog.healthmonix.com/topic/vbc), [COVID-19](https://blog.healthmonix.com/topic/covid-19) [All posts](https://blog.healthmonix.com/all) [Next](https://blog.healthmonix.com/topic/cms/page/2) ### Subscribe Here! ### Search the Healthmonix Advisor - [MACRA & MIPS (132)](https://blog.healthmonix.com/topic/macra-mips) - [Policy (77)](https://blog.healthmonix.com/topic/policy) - 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