Ron Ozminkowski

Digital health, AI and infrastructure startups can now come off the sidelines and invest in healthcare with confidence. I know you've burned through billions with no success because the healthcare industry lacks a common data platform. No longer. A common data architecture is coming to reality. https://lnkd.in/e_fpjGpA

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𝐌𝐞𝐝𝐢𝐜𝐚𝐫𝐞 𝐚𝐭 𝐚𝐧 𝐈𝐧𝐟𝐥𝐞𝐜𝐭𝐢𝐨𝐧 𝐏𝐨𝐢𝐧𝐭: 𝐌𝐀 𝐑𝐚𝐭𝐞𝐬 𝐚𝐧𝐝 𝐭𝐡𝐞 𝐑𝐢𝐬𝐞 𝐨𝐟 𝐅𝐅𝐒 𝐈𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧 Medicare Advantage (MA) now covers 54% of beneficiaries, up from 19% in 2007 (KFF). In 2025, payments to Medicare Advantage plans were estimated to be approximately 20% higher per enrollee than Traditional Medicare, resulting in roughly $84 billion in additional Medicare spending. CMS’s proposed modest 2027 MA payment update would slow revenue growth relative to prior years. If finalized, plans may adjust supplemental benefits, premiums, or cost-sharing, factors that influence enrollment decisions over time. At the same time, CMMI is releasing new models (e.g. ACCESS, LEAD) designed to make Traditional Medicare (FFS) more attractive for providers through downside risk, care management tools, and performance-based incentives. This combination is notable: • Slower MA revenue growth • Expanded innovation pathways inside FFS • More structured provider accountability under CMMI Rather than a dramatic shift, this may represent a gradual recalibration, strengthening value-based care inside Traditional Medicare while moderating the long-term cost growth associated with MA plan payments, leading to a rebalancing of FFS members and lower total cost to Medicare. Source: https://lnkd.in/ekBXWE27

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Navigating Shifting Medicaid Realities: A Shared Commitment to Our Communities The Medicaid landscape is entering a period of significant transformation. Following the Centers for Medicare & Medicaid Services (CMS) newly issued Interim Final Rule, states are working under a compressed timeline to deploy new workflows for work and community engagement requirements by January 1, 2027. When policy shifts this rapidly, the ripple effects are felt by everyone—state agencies, health plans, frontline providers, and, most importantly, the individuals and families who rely on these programs for care. The immediate challenge across the health ecosystem isn't just about regulatory compliance; it’s about mitigating administrative friction and preventing "enrollment churn." When complex determinations like medical frailty or caregiving exemptions are introduced, the risk of temporary coverage disruption rises due to documentation barriers—even for those who qualify. A Closer Look at Local Adaptations We are seeing distinct operational strategies emerge as states build these new systems: - In Colorado, a phased rollout is underway. Backed by federal funding for data infrastructure, the state is pairing automated income verification with broad criteria for "medically frail" status to protect vulnerable populations. - Concurrently, Montana is moving toward immediate mid-2026 deadlines, putting rapid operational pressure on local providers to navigate un-automatable exemptions. - Across the board, Illinois is restructuring contract vehicles to separate state and federally funded services to meet complex rate guidelines. Moving Forward, Together Navigating changing environments like this requires a collective effort. Success won't be defined by how a single organization adapts, but by how well we collaborate across our shared services models to support the entire care ecosystem. There is no need to keep layering more manual tasks on top of already stretched systems; the focus must be on building smarter infrastructure. As we look toward the 2027 implementation deadline, we should be asking ourselves: - Do our frontline workflows support complex exemption documentation without disrupting patient care? - Are we optimizing data integration across workforce and social services to maximize automated verification? - How can we deploy clear, compassionate communication pathways to reach at-risk populations early? The federal comment window on this Interim Final Rule is open through July 31, 2026. Let’s use this time to share insights, strengthen local infrastructures, and ensure our systems remain resilient for the communities and individuals we all serve. Curious to know what you are hearing. How is your organization preparing to support members and providers through these upcoming operational shifts? Let’s get a conversation started below. #Medicaid #HealthPolicy #HealthcareOperations #HealthcareLeadership #CommunityHealth #OptimalHealthStrategies

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