Brandon Edwards

This CMS RFI is more about the technical aspects of data migration and cloud hosting, but it provides some interesting insights into design changes for the Medicare Current Beneficiary Survey (MCBS): The 2026 redesign, to be launched starting with the Fall 2026 data collection, will employ a national frame, which covers all 50 states and the District of Columbia. The sample will be stratified by state to provide approximately equal numbers of beneficiary interviews within each state. The redesigned approach will no longer rely on PSUs or SSUs, and all beneficiaries in the United States will be eligible for sampling and recruitment. In place of the PSUs and SSUs, the national frame will be partitioned by state, and within each state, beneficiaries will be selected at rates designed to preserve adequate representation of the under-65 disabled population, beneficiaries 65-79 years of age, and beneficiaries 80 years of age and older. There will no longer be additional stratification based on ethnicity. While both the current design and the 2026 redesign yield nationally representative samples, the new design will include sampled beneficiaries and completed interviews in each of the 50 states and the District of Columbia. Once fully implemented, the 2026 redesign will allow for state-level and subnational region-level estimation, while continuing to support national-level estimation for the many domains of interest. https://lnkd.in/eFxDWpvv

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Health care CEOs face a pivotal moment defined by two converging forces: the rapid advancement of AI across the ecosystem and major changes to the Medicaid program that will significantly impact every health care organization. Together, these forces call for leaders to boldly redefine the way they think about Medicaid and innovation—and to seize opportunities to create solutions that build a more resilient safety net. As new federal policy takes effect, how can organizations leverage AI to prepare for coverage shifts and address gaps in care? Health Evolution Members tackled this challenge in our Member Programming discussion: At the Intersection: Opportunities for AI and Medicaid to Shape the Innovation Ecosystem We were joined by: Corbin Petro, President, Carelon Behavioral Health Suchi Saria, PhD, Founder & CEO, Bayesian Health; Director of the Machine Learning, AI and Healthcare Lab, The Johns Hopkins University Adimika Meadows Arthur, CEO & Executive Director, Health Tech 4 Medicaid Cris Ross, Senior Advisor, Insight Partners; Board Director, CaringBridge; former Chief Information Officer, Mayo Clinic Mike Vennera, EVP & Chief Strategy, Technology & Operations Officer, Independence Blue Cross Toyin Ajayi, MD, CEO & Cofounder, Cityblock Health Join our community of health care’s senior leaders as a Health Evolution Member https://lnkd.in/gTHXaKYU

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2026 Is an Execution Year for Government Programs & Innovation Healthcare providers enter 2026 with something we haven’t had in a while: short‑term stability. Labor pressures have eased. Volumes have recovered. Margins while remaining thin have stopped eroding. But for organizations with significant Medicaid and Medicare Advantage exposure, this moment isn’t about relief. It’s about using predictability to fundamentally redesign how care is delivered and financed. Reimbursement headwinds are clearly forming: Medicaid cuts will phase in over the coming years Enhanced ACA subsidies are expiring Rate adequacy and risk adjustment scrutiny continue to intensify This gives leaders a narrow window to act. For government programs, innovation can’t be optional or incremental. The systems best positioned for 2027 and beyond are already: ✅ Reassessing program and market participation ✅ Investing in scalable, value‑based operating models ✅ Using data, analytics, and partnerships to manage risk not just volume ✅ Designing workforce and care models that work at public‑payer margins In an environment where 3–5% operating margins define success; execution matters more than ambition. Boards and regulators alike are asking tougher questions: Are we structurally prepared for lower reimbursement or waiting for policy relief? Innovation in 2026 isn’t about pilots. It’s about institutionalizing what works in Medicaid and Medicare Advantage today, before the financial pressure deepens. The runway is short but it’s real. How health systems respond at this moment in time will shape their options and access for communities for years to come.

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Digital member engagement has increased between 30-50% year over year, according to the findings from the Engagys LLC annual state of engagement survey. “Health plans are aligning engagement investments to measurable outcomes, proving what works, and scaling with precision,” Radford said in an announcement about the survey findings. “This year’s survey results show that the bar has moved from digital adoption to digital maturity. The next frontier is orchestration, automation, and intelligence at scale.” See the Findings: https://buff.ly/L6Z75To

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At a recent national meeting, CMS highlighted the upcoming ACCESS Model—an initiative launching in July 2026 that shifts Medicare payment toward outcomes and expands access to technology-enabled care. With 350+ organizations expressing interest and support from major clinical and payer groups, the model aims to modernize how digital health integrates into chronic care. Read the full breakdown 👉 https://hubs.li/Q03XxhtR0

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In Kaufman Hall’s newest article, Anu Singh and Amanda Steele note that traditional governance models are no longer enough in today’s disruptive healthcare environment. They highlight the need for boards—especially in not-for-profit health systems—to move from passive oversight to proactive, strategic leadership that redefines stewardship, drives adaptive decision-making, and stays true to the mission of serving patients, physicians, staff, and communities. https://lnkd.in/gfMehtMc

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It’s been an incredible fall for the Health Catalyst team—connecting, learning, and sharing insights across some of healthcare’s most impactful events. One highlight: at the Civitas Networks for Health Annual Conference, Shakeel Khan from Health Catalyst and Rachael Hartfield from OHIP presented “Taming Community Data for Scalable, Self-Service Analytics.” Key takeaways from their session included: - Health Information Exchanges (HIEs) are evolving—from transactional intermediaries to essential enablers of population health. - To drive value-based care and health equity, HIEs must turn raw community data into actionable insights. - A modern, cloud-based data pipeline can unify data, strengthen interoperability, and power self-service analytics. - Clear, filterable dashboards deliver actionable visibility into data quality, utilization, and outcomes—driving smarter collaboration. - Across 500+ facilities, these innovations improved data transparency, streamlined processing, and strengthened stakeholder engagement. As we wrap up a busy fall events season, we’re proud to partner with organizations nationwide driving measurable impact through analytics.

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Despite nearly 40% of programs targeting older adults, many still fall short in prioritizing key accessibility principles like digital literacy and offline capabilities. In order to effectively change this shortcoming, we must embed health equity into the design, development, and evaluation of digital health solutions from the beginning. By proactively addressing these systemic barriers and prioritizing health equity, we can create a strong foundation from which we can build a more accessible, just, and effective healthcare landscape in the future. #HealthEquity #DigitalHealth #HealthcareAccess

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As healthcare organizations prepare for increasing cost pressures and potential funding cuts, leaders will need to adopt models that are both fiscally responsible and mission-driven. One approach worth serious consideration is the development of a nonprofit cooperative structure. At Alliance Health Centers, we have implemented a cooperative model by embedding our clinical services within trusted community organizations across Fort Wayne. This structure allows us to share physical space and operational infrastructure, increasing efficiency while expanding access to care in neighborhoods that need it most. This is not simply co-location. It is a strategic alignment of missions, workflows, and community engagement. Patients receive medical, behavioral health, and social services in one place, supported by organizations that already hold community trust. Our CEO, Dr. Nikki King, and COO, Ashley Piercy has led this work with a clear vision: build sustainable systems that remove barriers, reduce duplication, and center care in the community. This grassroots approach has proven to be both practical and forward-thinking. As the healthcare landscape shifts, cooperative strategies like this one offer a compelling path forward. They help safeguard services, maximize limited resources, and keep the focus where it belongs - on patient access and community impact. Alliance Health Centers is committed to expanding this model and welcomes dialogue with other leaders exploring similar approaches. #HealthcareLeadership #HealthEquity #FQHC #NonprofitStrategy #PrimaryCare #BehavioralHealth #CommunityCare #CostSaving #IntegratedCare #AllianceHealthCenters #DrNikkiKing #PublicHealthInnovation

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At the Mindshare Institute, we’re always exploring ideas that challenge conventional thinking—and the Health Care Utility Model is one that is central to who we are. In the paper “A Novel Approach to Doing Business,” the authors propose a model that treats health care infrastructure as a public utility—prioritizing access, affordability, and sustainability over profit maximization. It’s a bold reimagining of how we deliver care, especially in areas where market dynamics fail to meet public needs. This model invites us to ask: What if health care operated like electricity or water—essential, reliable, and equitably distributed? As leaders, we have the opportunity to shape systems that serve people first. Let’s keep pushing the boundaries of what’s possible. Check below for the link to the full article. #MindshareLeadership #HealthCareInnovation #UtilityModel #SystemRedesign #LeadershipInAction

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Ochsner Digital Medicine CEO Dan Shields participated in the opening panel discussion at Cambridge Healthtech Institute's inaugural Innov8 Health conference in Boston. Shields was joined by Gil Addo, Beth Careyva, David Guidry and moderator Andy Molnar. The panel, “Reimagining Healthcare Delivery—From Concepts to Scalable Realities,” explored crucial questions about the future of care delivery. Panelists also discussed what’s working and what’s not working with emerging tech-focused approaches in healthcare delivery. We were happy to discuss how technology can be used in the transformation of care. The Innov8 Health conference provided a valuable opportunity to explore how to ensure patient care is delivered effectively and sustainably.

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In recent earnings calls, executives from Elevance Health and Centene pointed to provider coding intensity as a primary driver of inflation. But providers believe they are just going after revenue that they deserve. The payers comments come as the healthcare industry engages in a broader discussion over the AI arms race. As payers deploy tech to deny and delay payments, providers feel they need to their own tools to play defense. “When we talk about payers, they’ve been in the AI space probably a little ahead of us as healthcare providers,” Christina Slemp, System VP of Revenue Cycle at UNC Health, said during a recent HealthLeaders webinar. “And so, I think we’re just catching up.” https://lnkd.in/eVtpMCuN #RevenueCycle #RevenueCycleManagement #AIinHealthcare #HealthInsurance #Payers #Denials #HealthLeaders

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Per Becker's Healthcare they reference a Kaufman Hall study on how M&A is heating up again now that there is more certainty on what lies ahead given the new federal bill being signed. Strategic active archiving should be a part of health system M&A thesis to address cost reduction synergies faster for OpEx and TSA costs faster.

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As health systems enter 2026, they are facing unprecedented changes to federal funding as well as sustained margin pressure, capital constraints, payer friction and ambulatory migration. Chris George shares perspectives on what he views as the most undervalued asset in health systems—the physician enterprise. Click here to read more: https://okt.to/W2jie3 #AMHealthcare #HealthSystems

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Industry conversations continue to shift toward compliance, transparency, and accountability in healthcare cost management. These themes are becoming central to how organizations think about sustainability and long-term value, and they’ll be front and center at this year’s HCAA Executive Forum. #hcaa #hcaaexecutiveforum #vativorx #medicalrebates

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In our work transforming cardiometabolic and primary care delivery in underserved communities, we see the same reality: the magic happens when smarter risk stratification is tightly coupled with team-based workflows and aligned incentives.

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The 2027 Medicare Advantage Advance Notice by the Trump administration has set the stage for a new era in healthcare. It’s clear that success will depend on operational discipline rather than financial engineering. Craig R. Savage from A&M Healthcare Industry Group shares insights on how this policy shift is already reshaping the market. Discover more here: https://okt.to/JSuzsr

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