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Venture Capital: Risk Capital_Angel, Venture, Sovereign Wealth Investor Companies & Organizations
Thrive Capital
Business Development & Investment Terms and Frameworks
Healthcare Policy & Stakeholders
Medicare
Parents
Healthcare Policy & Stakeholders
Children
* Offers Medicare advantage, prescription drug, and supplement plan quoting and enrollment services
* Uses technology to better connect patients to comprehensive care and support to Medicare patients
*”Architects”: Geriatrics, Gerontology, Geroscience, Longevity, Healthspan & Aging
**Key People: CMS (Centers for Medicare & Medicaid Services)
*2019: CMS Innovation Center Announces Awardees for the Integrated Care for Kids (InCK) Models
*2019: CMS Innovation Center Announces Awardees for the Maternal Opioid Misuse (MOM)
*Anthem Insurance Companies, Inc.
*CareBridge is a provider of medicare and medicaid healthcare systems for patients and caregivers.
*CareBridge was founded in 2019 by former Center for Medicare and Medication Innovation Director Brad Smith and former Senator Bill Frist.
*Centene's federal market aims through the deal include the expansion of its footprint in the Department of Veterans Affairs and the Medicare and Tricare programs.
*Centers for Medicare and Medicaid operations – $3.6 billion. (Entitlement funding, Social Security, Medicare, and Medicaid, are not addressed in Appropriations bills.)-2014
*Chronic Conditions Overview
*Clover is a next-generation Medicare Advantage insurance company offering best-in-class plans that combine wide access to healthcare and rich supplemental benefits with low out-of-pocket expenses.
*CMS TCET (Transitional Coverage for Emerging Technologies) _ CMS-3421-FN)
*CMS: NTAP (New Technology Add-on Payments) Program
*Conferences and Meetings: HHS _ Health Policy, CMS, MEDICARE / MEDICAID, Insurance, Payors, Revenue Cycle Management (RCM), Value Based Care (VBC), Population Health, Quality, Patient Experience, Equity, SDOH, Equity, Disparity, CER, IDD & Reform
*Conferences and Meetings: HHS _ Health Policy, CMS, MEDICARE / MEDICAID, Insurance, Payors, Revenue Cycle Management (RCM), Value Based Care (VBC), Population Health, Quality, Patient Experience, Equity, SDOH, Equity, Disparity, CER, IDD & Reform_2024 & Earlier
*Consolidators: Health Insurance, Plans, HMOs, MEDICAID/MEDICARE Managed Care Companies
*Contractors & Awardees: CMS
*Contractors & Awardees: HHS
*Driving Forces: Biotechnology_ Cell, Gene, Genomic Editing & Therapy, CRISPR, Genetics
*Driving Forces: Cancer and Oncology
*Driving Forces: Health Information Technology (Health IT), Medical Informatics,, Interoperability _ EHR, PHR & HIE
*Driving Forces: Health Systems & Policy_MEDICARE/MEDICAID, Medical Home, ACOs (Accountable Care Organizations), Healthcare Delivery, Hospitals & Health Insurance (Trends)
*Driving Forces: Health Systems_MEDICARE/MEDICAID, Medical Home, ACOs, Healthcare Delivery, Hospitals & Health Insurance (Clinical Specialties)
*Driving Forces: Health Systems, Plans & Policy_MEDICARE/MEDICAID, Affordable Care Act (ACA), FQHCs, Medical Home, ACOs, Healthcare Delivery, Hospitals & Health Insurance
*Driving Forces: Health Systems, Plans & Policy_MEDICARE/MEDICAID, FQHCs, Medical Home, ACOs, Healthcare Delivery, Hospitals & Health Insurance (Facts & Figures)
*Driving Forces: Health Systems, Plans & Policy_MEDICARE/MEDICAID, FQHCs, Medical Home, ACOs, Healthcare Delivery, Hospitals & Health Insurance (Sectors)
*Driving Forces: Telemedicine,Telehealth, Mobile Health, mHealth, Virtual, Digital Health, DTx (Digital Therapeutics)
*Funding: Health Information Technology (Health IT) & Bio-Medical Informatics
*Funding: Health IT _ Technical Assistance (TA), Professional, Administrative & Consulting Services, Business Staffing, Scientific & Statistical Support Services, Help Desks, End User IT Support
*Funding: Health IT_Medical Coding
*Funding: HHS (Subordinate Organizations)
*Funding: HHS_ACL
*Funding: HHS_CMS
*Funding: HHS_HRSA
*Funding: HHS_SAMHSA
*Funding: IT Project Management_Information Technology (IT), Information Management (IM), Systems Integration, Test & Evaluation (T&E), Software Development (SDLC)_Agile, DevSecOps, Data Management, Data Warehouse, Data Repository, Databases, Data Lakes, Digitization, Network Support, 508, Open Source, Social Media/Networks, Web Design & Graphics, CRM, Software License Management, IT Procurement, Life Cycle Management
*Funding: MEDICAID, MEDICARE, TRICARE, VHA, VBC (Value Based Care), Practice Transfromation, HRO (High Reliability Organizations), HSR&D (Health Services Research & Development), Enterprise Modeling & Policy, Managed Care
*Funding: Medical Logistics, Acquisition Support, Product Tracking, RTLS, Supply Chain Management, Pharmacy, Pharmacists, Pharmacy Information Systems & Pharmacy Benefit Management (PBM)
*Funding: Mobile Health Vehicles, Casualty Evacuation, Patient Transport, Enroute Care & Monitoring
*Funding: Patient Centered Outcomes Research (PCOR), Comparative Effectiveness Research (CER), HEOR (Health Economics and Outcomes Research)
*Funding: Public Health, Epidemiology, Population Health, Health Surveillance , Preventive Medicine
*Funding: Sickle Cell
*GoHealth is a health insurance marketplace that offers health insurance brokerage and medicare plans for individuals and businesses.
*Greens Health supports Medicare seniors and caregivers with tools to manage blood pressure, medications, and meals—offering peace of mind through culturally tailored, convenient care.
*LEAD also will focus on better serving coordinated care for high-needs patients, such as those dually eligible for Medicare and Medicaid, and those who are homebound or home limited. LEAD is a 10-year voluntary model that runs from January 1, 2027, through December 31, 2036. ACOs can apply to participate in the model by responding to a Request for Applications beginning in March 2026.
*MACRA (H.R.2 - Medicare Access and CHIP Reauthorization Act of 2015)
*Medicare Advantage Plans
*Medicare advisory startup
*Medicare benefit category
*Medicare Geographic Variation
*Medicare Sustainable Growth Rate (SGR)
*Molina Healthcare, Inc. is a managed care company providing health insurance to individuals through government programs such as Medicaid and Medicare
*Next Generation ACO Model
*Organization: CMS
*Partners with more than 450 healthcare organizations, 80% of 4.5- and 5-star Medicare Advantage plans, and 50 of the 60 largest health plans
*Pioneers: Autism
*Pioneers: Sickle Cell and Beta Thalassemia
*Provider Enrollment Chain Ownership System (PECOS)
*Provider of prospective health assessments for Medicare advantage health plans.
*Provides healthcare payers and pharmacies with technology to deliver insights and guidance to support medication management for Medicaid, Medicare and commercial populations.
*Provides MEDICARE plan comparisons, enrollment assistance, and support based on individual needs
*The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Original Medicare to expand access to new technology-supported care options that help people improve their health and prevent and manage chronic disease. The voluntary model focuses on conditions affecting more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression. It will run for 10 years beginning July 5, 2026.
*The Centers for Medicare & Medicaid Services (CMS) is committed to increasing access to health care services in ways that can narrow disparities in rates of care, promote quality education and achievement, and build a reliable system of support for every young person. Schools are uniquely positioned to help increase health equity and to help ensure that all children, including adolescents, have access to necessary health care services. Although schools are primarily providers of education, the school setting provides a unique opportunity to: enroll eligible children and adolescents in Medicaid and the Children’s Health Insurance Program (CHIP), deliver covered services, including behavioral health services (mental health and substance use disorder (SUD) services) to eligible children, and help children who are enrolled in Medicaid or CHIP access the services they need.
*The firm provides healthcare services to patients under the Medicare Advantage plan in the United States.
*The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model is part of the Administration’s bold plan to reform America’s health systems to address the chronic disease epidemic. The model will provide approximately $100 million to fund 3-year cooperative agreements for up to 30 proposals that promote health and prevention for Original Medicare beneficiaries.
*The Medicare Diabetes Prevention Program (MDPP) Expanded Model is an evidence-based behavior change intervention to delay or prevent the onset of type 2 diabetes among people with Medicare. This voluntary model was certified for expansion in 2016 and is covered under Medicare Part B as a preventive service.
*The most recent evaluation of performance years 6 and 7 (2021-2023) showed that the CJR Model generated an estimated $112.7 million in net Medicare savings while maintaining quality for over 98,000 knee and hip replacement patients across 323 hospitals.
*The OneHHS approach encourages all HHS divisions—including the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and others—to work together on building a single Department-wide AI infrastructure.
*The proposals will utilize evidence-based, whole-person care approaches — including functional or lifestyle medicine interventions — currently not covered by Original Medicare. These approaches are intended to support, not replace, the medical care received by people with Medicare. MAHA ELEVATE will also gather and evaluate new data on cost and quality to inform future interventions promoting healthy lifestyle behaviors and ultimately reduce spending in Original Medicare. CMS will release a Notice of Funding Opportunity (NOFO) in early 2026 for the first cohort, and the voluntary model will launch on September 1, 2026.
*The proposed Ambulatory Specialty Model (ASM) aims to improve prevention and upstream management of chronic disease, which would lead to reductions in avoidable hospitalizations and unnecessary procedures. Participation in ASM will be mandatory for specialists who commonly treat people with Original Medicare for heart failure or low back pain in an outpatient setting across selected regions. ASM will begin on January 1, 2027 and run for five performance years through December 31, 2031.
*The risk score models of Medicare Advantage, Commercial Health Insurance Exchange, and state managed Medicaid are each supported within the ePASS system.
*The Wasteful and Inappropriate Service Reduction (WISeR) Model will help protect American taxpayers by leveraging enhanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), along with human clinical review, to ensure timely and appropriate Medicare payment for select items and services. The voluntary model will encourage care navigation, encouraging safe and evidence-supported best practices for treating people with Medicare. WISeR will run for six performance years from January 1, 2026 to December 31, 2031 in six states: New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The application period opened on June 27, 2025.
*Therapy costs $17,500 on average and is covered by Medicare.
*This notice announces the opportunity to apply for funding under the Medicare Rural Hospital Flexibility Program (Flex Program), Emergency Medical Services (EMS) Competing Supplement (EMS Supplement). The purpose of the EMS Supplement is to enable states to establish or expand programs for the provision of rural EMS by strengthening the EMS workforce in rural areas through recruitment, retention, and financial and operational strategies.
*United Healthcare Services, Inc. _ Health Insurance Plans - Group, Individual, Family, Medicare
*What’s new: CMS has proposed a nationwide expansion of the Comprehensive Care for Joint Replacement (CJR) Model to support an effective and positive recovery experience for people with Original Medicare undergoing hip, knee, and ankle replacements.
*Why it matters: The CJR-X (Comprehensive Care for Joint Replacement Expanded) Model would be the first nationwide mandatory episode-based payment model in Original Medicare, scaling the impacts of the CJR Model which ended on December 31, 2024
*XRHealth is the first company to create virtual reality clinics that provide remote care to patients throughout the United States and is covered by most major health insurance companies as well as medicare
2. MEDICARE, MEDICAID, Direct Care Expansion
2009: Medicare Acute Care Episode (ACE) Demonstration (2009)
2010: CMS establishes Center for Medicare and Medicaid Innovation (2010)
2010: CSC Books $230 Million Medicare/Medicaid IT Deal; Dr. Robert Wah Comments
2010: CSC gets Medicare contract worth up to $230M (2010)
2010: Its services aren’t currently reimbursed by Medicare, a key milestone (2010)
2011: CGI Awarded Five-Year, US$55 Million Task Order with the Centers for Medicare & Medicaid Services-CMS (2011)
2011: Cigna Agrees to Buy Healthspring Inc. for $3.8B, Expands Medicare Business
2011: CMS selects 5 participants in the Medicare Imaging Demonstration (MID) 2011
2011: General Dynamics keeps Medicare job (2011)
2011: Humana acquiring HMO Arcadian to boost Medicare enrollment (2011)
2011: Humana buys Medicare HMO MD Care (2011)
2012: CCTP Partners: Round 3 Site Summaries (2012)
2012: CMS selects 500 practices to boost Medicare primary care (2012)
2012: cms- MEDICARE PHYSICIAN GROUP PRACTICE DEMONSTRATION (2012)
2012: HHS Centers for Medicare & Medicaid Services Awards QSSI the Enterprise Identity Management Contract (2012)
2012: Technatomy Performing IV&V of Medicare and Medicaid Financial Systems. (2012)
2013: The Medicare Trust Fund transfer and annual fee on insured and self-insured plans does not take effect until 2013.
2014 Government Health Care Congress, Medicare and Medicaid, July 15-17, 2014, Washington, D.C.
2014: CMS - 2014-01-31 - Frontier Community Health Integration Project Fact Sheet - Applications are due: May 5, 2014
2014: CMS-1J1-13-001: Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare-Medicaid Enrollees = Award Ceiling: $3,000,000/10 - Closing Date: Jun 26, 2014
2014: CMS-1L1-15-003: Transforming Clinical Practices Initiative (TCPI)/Practice Transformation Networks (PTNs)=$ : Letter of Intent to Apply Due Date: November 20, 2014
2014: CMS-Medicare Shared Savings Program Accountable Care Organization Application, Notice of Intent: May 30, 2014
2014: CMS: Medicare and Pioneer ACOs saved $380M
2014: Frontier Community Health Integration Project Demonstration, Applications are due: May 5, 2014
2014: Historic release of Medicare data gives consumers unprecedented transparency on the medical services physicians provide and how much they are paid
2014: NCQA found the three best Medicare plans to be all from the Kaiser Foundation--in Southern California, Northern California and the Northwest.
2014: State Innovation Models Initiative: General Information
2015: Video: Humana CEO Bruce Broussard on technology, value-based pay and Medicare Advantage_modernhealthcare (2015)
2015: Allegheny Science & Technology wins $3.7m contract to provide support services to the CMS Center for Medicare and Medicaid Innovation (CMMI)
2015: An insurer's transformation: Humana's evolution into Medicare powerhouse offers strong lure to Aetna_modernhealthcare
2015: CACI to Help Implement Electronic Medicare Appeals Processing System; Ken Asbury Comments
2015: CACI wins $32M contract to support Medicare office processing environment
2015: CMS - Transforming Clinical Practice Initiative Awards_2015-09-29
2015: HHS-CMS- ACO Investment Model=$ :Summer 2015
2015: HHS-CMS-SBSS-16-287: ViPS Medicare System (VMS)=$ :Response Date: Jul 08, 2015
2015: Next Generation ACO Model
2016: Accountable Health Communities (AHC) Model Fact Sheet_2016-01-05
2016: Comprehensive Primary Care Plus
2016: HHS finalizes streamlined Medicare payment system that rewards clinicians for quality patient care
2016: Omada Health and Humana Partner to Reduce Diabetes Risk in People with Medicare
2016: Using Omada’s digitally-based Prevent program, and Humana’s decades of experience serving Medicare Advantage members, a cohort of 491 Humana Medicare Advantage beneficiaries achieved clinically-meaningful engagement and weight loss outcomes.
2017: Dexcom's Medicare rollout has begun, but impact on earnings will be gradual
2018: AHRQ_The Continuation of the Medicare Patient Safety Monitoring System (MPSMS)
2018: Cerner sinks $266M into Lumeris as part of strategic partnership targeting Medicare Advantage plans
2018: CMS_Collection and Management of HEDIS Medicare Health Outcomes Survey
2018: CMS_Sources Sought Notice for Medicare Administrative Contractor (MAC) Services, Medicare Parts A & B, Jurisdictions 5, 6 and E
2018: DHA_TRICARE Medicare Eligible Program (TMEP)
2019: CardioDx, maker of heart disease test, shutting down as Medicare rescinds coverage
2019: Centene $17B WellCare buy will boost Medicare footprint
2019: CMS_Federal agencies charge 24 in $1.2B Medicare telemedicine fraud scheme
2019: CMS_Medicare Advantage and Prescription Drug Plan Monitoring Methods
2019: CMS_Medicare Shared Savings Program Accountable Care Organizations (ACO) ACO Application, Coordinator Support, Compliance and Communication Support
2019: CMS_Sources Sought Notice for Medicare Administrative Contractor(MAC) Services DME JC. Medicare Part A & B JL & JK
2019: CMS_SOURCES SOUGHT NOTICE-Medicare Data Sharing Requirement
2019: DHA_TRICARE Medicare Eligible Program (TMEP)
2019: DoD_VA_Industry_Interoperability_Roundtable_Slides
2019: DOJ arrests 35 in $2.1B Medicare scam targeting seniors for fraudulent genetic testing
2019: HHS-IHS_Medicare Cost Reporting Services
2019: IHS_Medicare Cost Reporting Services
2019: New CMS ruling expands telehealth access to Medicare Advantage patients
2019: Telemedicine CEO pleads guilty to role in $424M Medicare fraud scheme
2020: CMS expands list of telehealth services that can get Medicare reimbursement
2020: CMS_Direct Contracting Model Options
2020: CMS_Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2020
2020: CMS_Sources Sought Notice - USING ADVANCED TECHNOLOGY IN MEDICAL REVIEW_SAM.gov
2020: scPharmaceutical Slidedeck_seekingalpha_attachment
2021: CareMax: Network Of Comprehensive Care Centers Serving Medicare Beneficiaries
2021: Certified Community Behavioral Health Clinic (CCBHC) Grant Awards
2021: FCC announces 62 recipients of COVID-19 telehealth funding totaling $42M
2021: Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years_www.healthaffairs.org
2021: iRhythm's future hazy after Medicare pricing saga erases 12-month high
2021: Lifespark scored $20 million in Series B funding. Virgo-Managed Fund and Medicare Advantage provider UCare led the round.
2021: Medicare Advantage startup Devoted Health rakes in $1.15 billion in Series D funding
2021: NASEM Panel_DRUG RESEARCH AND DEVELOPMENT FOR ADULTS ACROSS THE OLDER AGE SPAN
2021: PUTTING PATIENTS FIRST: CMS’ RECORD OF SUCCESS FROM 2017-2020 The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020
2021: The company has signed contracts to deliver its innovative solution to leading healthcare payors and providers, including Humana, Blue Cross and Blue Shield of North Carolina, SSM Health, Conviva Care Centers and partnerships with hundreds of nephrology providers through new Medicare payment models
2022: ACL_MIPPA Medicare Beneficiary Outreach and Assistance Program: Funding for OAA Title VI Native American Programs
2022: Booz Allen Hamilton_CMS awards Medicare Advantage support contract
2022: Centene bids adieu to Caremark, awards $35B PBM contract to Express Scripts
2022: Centene posts $738M in profit for Q3 as Medicare, Medicaid overperform
2022: CMA_2022 CMS Navigator Cooperative Agreement Awardees
2022: CMS_Data Exchange System (DEX) - LSJ
2022: CMS_SS_Medicare FFS Program – CBR and PEPPER program impact analysis_SAM.gov
2022: CNSI_Awarded 5-Year Contract by CMS to Operate and Advance its Medicare Advantage Encounter Data Processing System
2022: Fair Square Medicare secures $15M to build out digital care navigator for seniors
2022: GDIT_CMS_ Awarded $65 Million Cloud and Data Integration Contract by the Centers for Medicare and Medicaid Services
2022: HIGHPOINT DIGITAL, INC_CMS awards Medicare health care provider content planning & development contract
2022: IHS_R--RFP Package_Program Management Office (PMO) Support Services for the Indian Health Service (IHS)_SAM.gov
2022: NASEM_Catalyzing Innovative Health System Transformation_An Opportunity Agenda for the Center for Medicare & Medicaid Innovation |The National Academies Press
2022: NORC_CMS awards $8M Medicare-Medicaid Financial Alignment Initiative Operation Support task
2022: RAND Corporation (RAND)_CMS awards Medicare Ground Ambulance Data Collection task
2022: SAMHSA_RFI_SAMHSA's Role in Possible Agency Actions Regarding Mental Health and Substance Use Wellbeing in the Context of Climate Change and Health Equity
2022: VA_DA10--BIC Medicare Pricer contract (VA-22-00006938) (VA-22-00038201) _SAM.gov
2023: Analysis Finds Span of Years for New Technologies to Get Medicare Coverage in US
2023: CMS Announces New Dementia Care Model for Medicare Patient_medpagetoday
2023: CMS_ Minority Research Grant Program (MRGP) Department of Health and Human Services Centers for Medicare & Medicaid Services
2023: CMS_Medicare spending per beneficiary, year by year
2023: DHA_Kearney and Co. P.C., awarded a maximum $11,893,927 labor-hour contract modification (P00010) for financial statement audit services for the Defense Health Program (DHP), Medicare Eligible Retiree Care Fund, and Defense Health Agency Contract Resource Management.
2023: Financial Alignment Initiative for Medicare-Medicaid Enrollees
2023: Here are the 10 drugs that will be up first for Medicare price negotiation
2023: Transforming Medicare Coverage: A New Medicare Coverage Pathway for Emerging Technologies and Revamped Evidence Development Framework
2023: UnitedHealth Group execs bullish on Medicare Advantage growth amid risk adjustment overhaul
2024: Adaptive Biotechnologies Receives Expanded Medicare
2024: Ardelyx's Medicare Setback Casts Doubt On Long-Term Viability
2024: Ardelyx's Medicare Setback Casts Doubt On Long-Term Viability_seekingalpha.com
2024: CareDx Announces Transplant Community Secures Win Reaffirming Longstanding Medicare Coverage for AlloSure and AlloMap Testing
2024: CMS launches dementia care with alternative Medicare payments
2024: CMS_Medicare $2 Drug List Model – Request for Information (RFI) – Responses Due December 9, 2024
2024: Congratulations to, Williams Consulting, LLC., Catonsville MD who was awarded a $802,513 contract for administrative management and general management consulting services by the Centers for Medicare and Medicaid Services in Windsor Mill, MD.
2024: Discount drug company Waltz Health moves into Medicare market
2024: HRSA_Medicare Rural Hospital Flexibility Program – Emergency Medical Services Supplement
2024: HRSA_Medicare Rural Hospital Flexibility Program – Emergency Medical Services Supplement
2024: HRSA_Medicare Rural Hospital Flexibility Program_www.grants.gov
2024: Humana Q3 Earnings Review: The Medicare Advantage Madness May Finally Be Over
2024: Humana shares tumble as 2025 membership for its top-rated Medicare plans slump
2024: Humana Stock Slides as Medicare Advantage Rate Rise Disappoints—Key Level to Watch
2024: Humana: Medicare Advantage Is Just A Short-Term Problem_
2024: Humana: Medicare Advantage May Fail Without Regulator Intervention, Threatening Core Business_seekingalpha.com
2024: Medicare Advantage plans to see 2025 base pay fall
2024: Medicare Intravenous Immune Globulin (IVIG) Demonstration Final Report to Congress (2014-20
2024: Medicare pays millions for remote vital sign monitoring. Is it worth it?
2024: Medicare Two Dollar Drug List Model
2024: NASEM_Exploring Strategies to Improve Access to Behavioral Health Care Services Through Medicare and Medicaid: Proceedings of a Workshop–in Brief
2024: Novo Nordisk: Medicare Coverage To Unlock Another Big Market For Wegovy
2024: Novo Nordisk: Medicare Coverage To Unlock Another Big Market For Wegovy
2024: Organogenesis: Lurking Disruption With Recovery To Follow
2024: RFI_NIA Data Linkage Program (LINKAGE): Linking Research Data with Data from the Centers for Medicare and Medicaid Services (CMS) and other Federal Sources
2024: Telehealth and Medicine Today (THMT) _Original Research Articles - Collections by Year
2024: The Centers for Medicare & Medicaid Services (CMS) in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), welcomed 10 new states into the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program.
2024: Trump nominates Dr. Oz to oversee Medicare, Medicaid as CMS head
2025: 2025 Medicare, Medicaid, Duals & Commercial Markets Forum, March 25 - 27, 2025, Baltimore, Maryland
2025: A Unified Approach to Health Data Exchange - A Report From the US DHHS
2025: Chapter, a Medicare startup with links to Vance, Thiel, and Ramaswamy, just raised a round at $1.5B valuation
2025: Chris Klomp, the new Medicare director, has big ambitions
2025: CMS commits to tech initiatives to give Medicare patients, providers easier access to health data
2025: CMS deletes Medicare Advantage vision statement, signaling another shift from health equity
2025: CMS Posts Final Medicare DMEPOS Fee Schedule Rate for the MyoPro®
2025: CMS_RTI awarded CMS Medicare Diabetes Prevention Program (MDPP) Evaluation Task on RMADA II
2025: CMS_Rural Community Hospital Demonstration
2025: Congress extends Medicare telehealth flexibilities for 6 months
2025: DEPARTMENT OF HEALTH AND HUMAN SERVICES FISCAL YEAR 2026 Centers for Medicare & Medicaid Services Justification of Estimates for Appropriations Committees
2025: Errors in new Medicare plan portal mislead seniors on coverage
2025: Expect More Downside Risk in Medicare's Payment Models, CMS Official Says
2025: Guardant Health rises after Medicare ADLT status for colorectal cancer test_MSN
2025: HHS Announces “Dramatic Restructuring”
2025: Humana and Other Health Insurer Stocks Fall as US Vows to Step Up Medicare Advantage Audits
2025: JAMA_Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries_2830180
2025: Maryland's health care reimbursement system gets massive overhaul
2025: Medicare Diabetes Prevention Program (MDPP) Expanded Model
2025: Medicare physician pay has plummeted since 2001. Find out why.
2025: Medicare premiums to jump 10% in 2026
2025: Medicare Prior Authorization Pilot in 6 States: What to Know
2025: Medicare, Care Delivery, Medicare Advantage, and More_Health Affairs Sunday Update
2025: NIH, CMS Partner to Advance Understanding of Autism Through Secure Access to Select Medicare and Medicaid Data
2025: Postponed_CMS (Centers for Medicare and Medicaid Services) Quality Conference 2025, 17-19 March 2025, Baltimore, Maryland _ www.cmsqualcon
2025: Revenue Up 33%, Medicare Members Surge 30%
2025: RISE National 2025, March 11-14, 2025 San Antonio, Texas
2025: Scoop: Trump Medicare center to cancel eight payment trials
2025: UnitedHealth under criminal probe for possible Medicare fraud, WSJ reports
2025:UnitedHealth tumbles 9% on WSJ report the DOJ is investigating Medicare billing practices_Stock Chart Icon
2026: Announced late last year by the Center for Medicare and Medicaid Innovation, the ACCESS model will pay participants set rates to treat chronic conditions like diabetes, hypertension, high cholesterol, musculoskeletal pain, anxiety, and depression.
2026: CMS’ Oz envisions agentic AI in the hands of every Medicare beneficiary
2026: Health Affairs_An Agenda For CMS: Strengthen Integrated Care Programs For Dually Eligible Adults With Behavioral Health Needs
2026: Medicare's ACCESS chronic care pilot signs up 150 companies | STAT
21st Century Cures Act
Ability Networks, formerly, VisionShare
Advance Payment ACO Model
Advanced Technologies for CMS to use in Medicare Advantage and for CMS Contract-Level Risk Adjustment Data Validation (RADV) Audits
Aetna offers Medicare products, including Part D, across the U.S. and the District of Columbia, serving nearly 500,000 members c
Afya Medicare Specialized Center-Mbeya
AI Medical Record Review Tools in Medicare FFS
Akebia Therapeutics Inc. (NASDAQ: AKBA)*
Alexandra Mugge, MPH Director and Deputy Chief Health Informatics Officer, Centers for Medicare & Medicaid Services, HHS (2021)
Amy Bassano, MA Deputy Director, Center for Medicare and Medicaid Innovation (CMMI) Centers for Medicare and Medicaid Services (CMS)_2021
Analytics, Reporting, Clinical Quality Measures (CQM) & Population Health
Architects: Health Insurance & Plans (MEDICARE/MEDICAID), Employer Health Benefits Management & Exchange Companies
Artificial Intelligence (AI)
Avoid MEDICARE Fee Cuts
Ayesha D'Avena Senior Advisor at Centers for Medicare & Medicaid Services (2015)
BD _ Becton, Dickinson and Company (NYSE:BDX)
Between 1999 and 2004, imaging services grew more rapidly than any other type of physician service paid for by Medicare
Biogen Inc. (NASDAQ: BIIB)*
BioSphere Medical
Bundled Payments for Care Improvement (BPCI) Initiative: General Information
Cara Repasky, MBA Partner and Member, Healthcare and Medicare Practice, McKinsey & Company, Pittsburgh, PA (2024)
CareMedic automates billing and Local Medical Review compliance procedures for Medicare Part A receivables
CareMore
CareMore serves about 44,000 Medicare recipients in California and 10,000 in Nevada and Arizona
Carilion Clinic Medicare Shared Savings Company, LLC – Virginia
Center for Medicare and Medicaid Innovation (CMMI)_(Innovation Center)
Centers for Medicare Medicaid (CMS) Indefinite Delivery Indefinite Quantity (IDIQ) Blanket Purchase Agreements (BPA)
Certified Community Behavioral Health Clinics [CCBHCs]
CGI Federal Inc. (NYSE: GIB)
Chapter
Chris Klomp, Deputy Administrator and Director Medicare CMS and Chief Counsel, Senior Advisor, HHS Secretary (2026)
Chris Smith Ritter Acting Deputy Director and Director, Patient Care Models Group (PCMG) CMS Center for Medicare and Medicaid Innovation (CMMI)_2022
Cigna Health Group (CI)
Clinical Quality Measures Basics
CMI (Center for Medicare and Medicaid Innovation)
CMS (Centers for Medicare & Medicaid Services), HHS
CMS Artificial Intelligence Stage 1 Awardees
CMS Innovation Models (Funding)
CMS Survey and Certification Group (SCG) National Surveyor Training Program (NSTP)
CMS-Centers for Medicare and Medicaid, which together cover more than half of all insured Americans
CMS: InCK (Integrated Care for Kids)
Community Based care Transition Program
company that provides custom-made insurance plans for seniors called Medicare Advantage
Connecture Acquires DRX, A Leading Provider of Information Systems for Medicare
Contractor that handles public’s Medicare queries will do same for Affordable Care Act (2013)
Dan Jamieson, MBA Partner and Member, Healthcare and Medicare Practice, McKinsey & Company, Chicago, IL (2024)
Daniel Petkevich, founder and CEO of Fair Square Medicare (2022)
Data Computer Corp. of America has won a $60 million contract from the Centers for Medicare and Medicaid Services to provide technical support.
Democrats are now promising the push down those prices by having the government negotiate drug prices for Medicare recipients
Devoted Health
DHA_TRICAREVBID_Apr_2019
Douglas B. "Doug" Jacobs, MD, Chief Transformation Officer, Center for Medicare, Centers for Medicare and Medicaid Services [CMS], HHS, Former Chief Medical Officer and Chief Innovation Officer, Pennsylvania Department of Human Services (2024)
Dr. Dora Hughes Chief Medical Officer CMS Center for Medicare & Medicaid Innovation (2023)
Dr. Douglas Jacobs Chief Transformation Officer CMS Center for Medicare (2023)
Dr. Liz Fowler Deputy Administrator and Director CMS Center for Medicare & Medicaid Innovation (2023)
Dr. Sarah Fogler Acting Director, Patient Care Models Group CMS Center for Medicare & Medicaid Innovation (2023)
Dr. Sarah Gaillot Deputy Director, Division of Consumer Assessment and Plan Performance CMS Center for Medicare (2023)
Dr. Susannah Bernheim, MD, MHS Chief Quality Officer/Senior Advisor CMS Center for Medicare & Medicaid Innovation (2023)
eCQM Library
Edward Dolly Director, Division of State Systems, Center for Medicare & Medicaid Services (2021)
Elizabeth Fowler, PhD, JD Deputy Administrator and Director, CMS Center for Medicare and Medicaid Innovation, Former EVP of Programs, The Commonwealth Fund, Former VP, Global Health Policy, Johnson & Johnson, Former Special Assistant to President Obama, Former Chief Health Counsel, Senate Finance Committee, Washington, DC (2024)
Ellen Lukens, MPH Deputy Director, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services (2024)
Extend Health, Inc._Medicare, Health Insurance Exchange, Medical Insurance (2012)
Fair Square Medicare
FHIR (Fast Healthcare Interoperability Resources)
FHIR (Fast Healthcare Interoperability Resources) Overview
Finance & Acquisitions: Fair Square Medicare
Fingertip Formulary maintains the highest quality and most comprehensive, integrated database of formulary information in the United States, covering virtually all commercial, Medicare, Medicaid and PBM plans.
found a nearly 8% reduction in hospital admissions among Medicare patients assigned a medical home and a 4% reduction in medical
Gabe Isaacson, MBA Associate Partner and Member, Healthcare and Medicare Practice, McKinsey & Company, Pittsburgh, PA (2024)
Gina Kolata-Medicare
Glenn Hackbarth Chairman, Medicare Payment Advisory Commission, Washington
Greens Health
Has 26 clinics in California, Nevada and Arizona that specialize in caring for people on Medicare
Health Net Federal Services (HNFS) LLC
HealthLeaders-InterStudy analyzes health plans, specific geographic healthcare markets and the managed Medicare and Medicaid markets to produce databases and reports that give healthcare businesses ready-access to the information needed for strategic and t
HIE (Health Information Exchange)
HMS-to-be-acquired-by-Gainwell-final-12.21.20
Hospital-at-Home
Humana Inc. (NYSE:HUM)
IDIQ (Indefinite Delivery/Indefinite Quantity), MAC (Multiple Award Contracts), GWAC (Government Wide Acquisition Contract), MATOC (Multiple Award Task Order Contract)
ikaSystems is the premier provider of enterprise-wide process automation and intelligence management technology supporting health insurers’ commercial, Medicare and Medicaid lines of business.
Improves customer service for health plans, consumer-directed health plans, Medicare plans and physician practices.
In addition to these proven cost benefits, Neighborhood Diabetes has built a strong reimbursement infrastructure that provides for DME or pharmacy adjudication of claims for private insurers, Medicaid and Medicare.
Includes a self-guided process for post-discharge assessments, an important consideration as Medicare gets ready to cut reimbursements for some preventable readmissions.
Industry: Southern California
Interoperability - FHIR, APIs, Etc.
JASON McNAMARA, Technical Director for Health IT at Centers for Medicare & Medicaid Services, Department of Health and Human Services (CMS/DHHS) - 2014
Jean Moody-Williams, Deputy Director, Center for Clinical Standards and Quality (CCSQ), Centers for Medicare and Medicaid Services (CMS) - 2015
Kate Davidson Director, Learning and Diffusion Group CMS Center for Medicare & Medicaid Innovation (2023)
Kate Goodrich, Federal Representative, Centers for Medicare and Medicaid Services (CMS)
Kate Goodrich, MD Chief Medical Officer, Humana, Former Chief Medical Officer, Centers for Medicare and Medicaid Services (2024)
Key People: Fair Square Medicare
LCDR Shondelle Wilson-Frederick, Ph.D., Technical Director for Analytics in the Division of Quality and Health Outcomes,Centers for Medicare & Medicaid Services (2021)
Leading provider of healthcare IT and informatics, supporting Medicare-related IT systems and professional services at the Centers for Medicare and Medicaid Services (CMS)
LifeMD, Inc. (NASDAQ:LFMD), formerly, Conversion Labs (OTCQB:CVLB), formerly, Immudyne, Inc.
Lisa Bari, MBA, MPH, Interim Chief Executive Officer, Strategic Health Information Exchange Collaborative, former, Center for Medicare & Medicaid Innovation, CMS_(2020)
Lucinda Wade, Product Manager, Digital Service at the Centers for Medicare & Medicaid Services (CMS)_2023
Lumeris is the nation’s first full-service enabler of accountable delivery systems such as accountable care organizations (ACOs), star-rated Medicare Advantage plans, virtually integrated delivery networks (IDNs) and bundled payment programs.
MACRA: MIPS & APMs
MEDICAID/MEDICARE Reform
MEDICARE
Medicare (Medicare Advantage)
Medicare Administrative Contractors (MAC)
MEDICARE ADVANTAGE NEWS
Medicare and several HMOs are already paying for the procedure.
MEDICARE COMPLIANCE
Medicare coverage & reimbursement was the #3 factor affecting ability to develop new medical technology at 72%, 2003
Medicare Fee Schedule
Medicare Improvements for Patients and Providers Act (MIPPA)
Medicare innovation center launches
Medicare Medical Home Demonstration
Medicare Modernization Act of 2003
Medicare Part D
Medicare Payment Advisory Commission
Medicare Payment Advisory Commission (MedPAC)
Medicare pays $135 for a digital mammogram and $85 for film,
Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations (2011)
Medicare Value Partners – Illinois
Medicare-eligible beneficiary needs
Medicare'Medicaid
Mehmet Oz Administrator, Centers for Medicare & Medicaid Services (2025)
Melanie Fontes Rainer, MSME, JD Director, Office for Civil Rights, HHS, Former Senior Advisor, Healthcare, Attorney General, CA DOJ, Former Chief of Staff, Medicare-Medicaid Coordination Office, Centers for Medicare & Medicaid Services (2023)
Molly T. Turco, MPH Senior Advisor, Center for Medicare, Centers for Medicare & Medicaid Services (2024)
Myomo, Inc. (NYSE: MYO)*
Newest version of GE's Centricity Cardiology (v4.1) addresses the paperwork challenge for labs needing to qualify for Medicare r
No funding will be obligated at time of award, but fiscal 2024 operations and maintenance and Medicare-Eligible Retiree Health Care Fund funding will be obligated when made available.
Nora Fleming Senior Advisor CMS Center for Medicare & Medicaid Innovation (2023)
Noridian Healthcare Solutions
Nuwellis, Inc. (NASDAQ: NUWE)*
Operator of the nation’s largest private Medicare exchange
Organization & Developments: CGI
Organization & Developments: CMS
Organization & Developments: Fair Square Medicare
Organization & Developments: HHS
Organization: HHS (Operational Divisions_OpDivs, Agencies, Administrations,Centers & Institutes)
Pauline Lapin, Senior Advisor for the Center for Medicare and Medicaid Innovation and Deputy Director for the Seamless Care Models Group (2014)
Pioneer ACO Model
Preventing or delaying transitions of Medicare members with heart disease to higher levels of care settings using mHealth and wireless solutions.
Primary Care & PCMH (Patient Centered Medical Home)
Prior Authorization
Provider of disease management systems to manage health and the largest disease management service provider to Medicare managed
Provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 24 million Medicare beneficiaries and 110,000 healthcare professionals nationwide.
PROVIDES MANAGED HEALTHCARE SERVICES PRIMARILY THROUGH MEDICARE TO 1,028,998 MEMBERS
PROVIDES MANAGED HEALTHCARE SERVICES THROUGH GOVERNMENT PROGRAMS SUCH AS MEDICAID AND MEDICARE TO 2.26 MIL MEMBERS
PROVIDES MANAGED HEALTHCARE SERVICES THROUGH SPONSORED PROGRAMS, INCLUDING MEDICAID AND MEDICARE, TO 1.9 MIL MEMBERS
Qualified rural health clinics receive extra MEDICARE/MEDICAID payments
Quentin Tyson Chief Technology Officer, CCSQInfo Systems Group, Centers for Medicare & Medicaid Services (2022)
Regeneron Pharmaceuticals, Inc. (NASDAQ:REGN)
Rehab clinics can bill Medicare for these expenses at the same rates fetched by other therapies aimed at restoring ambulation.
Remote Therapeutic Monitoring (RTM) under Medicare involves using medical devices to collect and monitor non-physiological data related to a patient's musculoskeletal or respiratory system, therapy adherence, and therapy response, with specific CPT codes for billing
Renalytix plc (NASDAQ: RNLX)*
Reports, Plans, Studies, Proceedings, Analysis, Visualizations, Peer Reviewed Articles, Books, Publications, Rules & Policy Guidance
Samuel Schaffzin, Capt., USPHS Deputy Director, Division of HITECH & MMIS, Center for Medicare & Medicaid Services (2021)
SDOH (Social Determinants of Health) & HRSNs (Health Related Social Needs)
Seema Verma, Director, Oracle Health, MPH, former, Administrator, Centers for Medicare & Medicaid Services (2025)
Shannon (Sartin) West Chief Technology Officer - Center for Medicare & Medicaid Innovation, CMS (2021)
Shared Savings Program
Smartlink Health Solutions
Statewide effort to improve care for patients with diabetes, particularly in “medically underserved,” by Centers for Medicare &
Stuart Guterman, Vice President, Commonwealth Fund, former, Director, R&D, MEDICARE
Tasks include administration of the PAM survey, providing training, conducting analysis, and offering scoring support for the implementation of PAM within the CMS framework. The PAM survey is a tool used to assess an individual's knowledge, skills, and confidence in managing their own health and healthcare. The results from the survey help categorize patients into different levels of activation, which can then be used to tailor healthcare interventions and improve health outcomes. The implementation of PAM is particularly relevant for CMS's Alternative Payment Models (APMs) under the Center for Medicare and Medicaid Innovation (CMMI), where patient engagement is a critical factor for success. This contract reflects CMS's ongoing commitment to improving healthcare quality by empowering patients through better understanding and management of their health .
Telemedicine for the Medicare Population—Update February 2006
Telemedicine_Telehealth: Home Health
Teresa Fryer, Director Enterprise Information Security Group, Centers for Medicare and Medicaid (CMS)-2014
The ACCESS Model is designed to expand choice for patients and clinicians by oering a new payment option that removes payment barriers to technology-enabled care, while maintaining accountability for clinical and patient reported outcomes. The model is expected to reduce Medicare expenditures by enabling eicient care that achieves improved clinical outcomes and prevents avoidable utilization
The Administration for Strategic Preparedness and Response (ASPR), Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator for Health Information Technology (ONC) are seeking broad public input from entities across the health care readiness community on a national, all-hazards standardized set of essential elements of information (EEIs) and vendor-neutral data collection mechanisms for hospital data that drive action for emergency preparedness and response.
The bill meant small community hospitals would be eligible to get higher levels of Medicare reimbursement
The hospital or clinic bills third-party payors, such as managed care organizations, insurance companies, Medicare or Medi-Cal.
The Innovation in Behavioral Health (IBH) Model (the “Model”) for Cohort II Recipients is a seven-year, voluntary service delivery and payment model promoting integrated care in behavioral health (BH) settings. The IBH Model will test the impact of a value-based payment (VBP) model aligned across Medicaid and Medicare that supports an integrated care delivery framework in specialty BH organizations and settings for adult Medicaid, Medicare, and dually eligible beneficiaries with moderate to severe mental health conditions and/or substance use disorders (SUDs).
The Innovation in Behavioral Health (IBH) Model (the “Model”) is an eight-year, voluntary service delivery and payment model promoting integrated care in behavioral health (BH) settings. The IBH Model will test the impact of a value-based payment (VBP) model aligned across Medicaid and Medicare that supports an integrated care delivery framework in specialty BH organizations and settings for adult Medicaid, Medicare, and dually eligible beneficiaries with moderate to severe mental health conditions and/or substance use disorders (SUDs).
The Medicare Modernization Act of 2003.
The mission of the Administration for Community Living (ACL) Senior Medicare Patrol (SMP) program is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse.
The purpose of the Sources Sought Notice is to find an ideal vendor(s) to build the 13th Scope of Work with Quality Improvement Organization (QIO) program under the direction of the Centers for Medicare & Medicaid Services(CMS).
The purpose of this RFI is to solicit comments and suggestions that the National Institute on Aging (NIA) will consider as strategies to make linked data - combining Centers for Medicare & Medicaid Services (CMS) data and data from other Federal sources with data from NIA-funded studies - available to NIA grantees and other researchers in a secure environment (enclave) for the purposes of data analysis and sharing.
Therapractic Management Systems provides online office assistance for behavioral health practices and manages risk with HIPAA-based training and Medicare- and Medicaid-sensitive notes.
These facilities bill third-party payors such as managed care organizations, insurance companies, Medicare or Medi-Cal.
Through outreach, counseling, and education, the SMP program increases awareness and understanding of health care programs to protect Medicare beneficiaries from the economic and health-related consequences associated with Medicare fraud, errors, and abuse.
TRICARE Medicare Eligible Program (TMEP)
TTVR (Transcatheter Tricuspid Valve Replacement)
Twice the rate of increase of MEDICARE
U of U Health is comprised of the following: Five hospitals and 12 community health care centers University of Utah Medical Group with 2,000 members Highly-ranked $458 million research enterprise (FY22) Six schools and colleges, including the colleges of Health, Nursing, and Pharmacy, the Eccles Health Sciences Library, and the schools of Dentistry and Medicine 282,000 member health plan, offering medical, mental health, and pharmacy benefits for fully insured and self-funded employer groups, individuals, and families, as well as Medicare and Medicaid ARUP Laboratories, one of the nation’s largest reference laboratories Numerous institutes and centers reflecting the health system’s strengths in oncology, cardiology, diabetes treatment, genetics, ophthalmology, orthopedics, neuroscience, psychiatry, precision medicine, population health, global health, and more
Under the contract, DCCA will serve as CMS’s single testing contractor, providing technical support services to test the functionality across Medicare Claims Processing Systems
VBC - Value Based Care & Reimbursement
Victoria Wachino, director of the Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services (CMS), HHS (2015)
WellCare Health Plans provides government-sponsored managed care services to families, children, seniors, and individuals with medical needs through Medicaid, Medicare Advantage, and Medicare Prescription Drug Plans, as well as individuals in the health insurance marketplace
Will consist of funding streams from general revenues, an annual $2 fee per Medicare beneficiary transferred from the Medicare Trust Fund, and an annual $2 fee per-covered-life assessed on private health plans.
Wound Management’s primary focus is the distribution of its unique, patented collagen product, CellerateRX®, which is FDA cleared and reimbursable under Medicare Part B.
Jumps
Medicaid