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Whitepapers, briefs, press releases and more
Transitioning from ACO REACH to MSSP? Key Considerations for Making the Shift
Should your ACO consider a move from REACH to MSSP? The Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model in its current form is scheduled to conclude by the end of the 2026 performance year. Although organizations, such as the National Association of Accountable Care Organizations (NAACOS), are actively lobbying in ... Read more
Impact of Final 2026 Federal Actuarial Value Calculator Updates
The 2026 Federal Actuarial Value Calculator (AVC) was released on October 16, 2024. The new version is methodologically similar to prior AVC models after two years in a row of substantial data updates and methodological changes. That does not mean the impacts will be mild though, as inflation continues to drive high trend which will ... Read more
Week in Washington 01/16/25
New Administration Personnel Several news outlets (notably the Washington Post and Politico) reported on expected key personnel at CMS. These individuals include: Last CMS Regulations from the Biden Administration CMS released several key regulations. These included: Preventative Services at Supreme Court The Supreme Court announced it will take up a case involving preventative services requirements. ... Read more
Events & More
Kelsey Stevens named Wakely CEO
We are pleased to announce that Kelsey Stevens, principal at Wakely Consulting Group, an HMA Company, has been named the new chief executive officer (CEO) of Wakely. Kelsey succeeds Mary Hegemann, who recently was promoted to executive vice president at HMA.
A respected and trusted leader, Kelsey has been an integral part of Wakely since 2012, fostering a culture of collaboration, innovation, and excellence. As a champion for both internal teams and client solutions, she has guided Wakely through complex challenges and significant growth. Her leadership combines a deep understanding of healthcare markets with technical expertise and strategic vision, ensuring the continued delivery of exceptional results for clients.
“I’m deeply honored to take on this role and excited for the future of Wakely. Our work has always been about empowering clients with innovative, data-driven solutions, and with the support of our HMA family, we’re uniquely positioned to make an even greater impact,” Kelsey said. “I look forward to collaborating with our incredible team as we navigate the challenges and opportunities of an evolving healthcare landscape.”
With over 18 years of experience in the healthcare field, Kelsey brings expertise in pricing, and rate development, regulatory filings, product design, and financial forecasting. She has worked extensively with health plans, providers, and government agencies across both commercial and government programs, including supporting several accountable care organizations participating in CMS and CMMI programs. She is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries.
Kelsey will continue to work out of the company’s Tampa Bay, Fla. office.
Wakely Webinar: Summary & Impactions of 2026 Medicare Advantage Advance Notice & Draft Part D Redesign Instructions
The Centers for Medicare & Medicaid Services (CMS) recently released the 2026 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C/D Payment Policies, which proposes important changes in plan payments, risk adjustment and other key financial and regulatory requirements for 2026. During this webinar, Wakely consultants will provide an overview of the proposed changes, with an emphasis on the likely impact that the new rates and policies will have on Medicare Advantage bids, membership growth, quality and strategy. Speakers will also touch on the important items from the Draft CY 2026 Part D Redesign Instructions, released on the same day as the Advance Notice.
Newsworthy Findings
CMS Expands Enforcement Power Over Shady ACA Brokers
A rule finalized Monday makes it easier for regulators to suspend agents and brokers from selling Affordable Care Act plans if they pose a risk to the exchanges.
Feds Extend Enforcement Discretion for Out-Of-Network Pay Disputes to Aug. 1
The federal government is giving payers an extended grace period as they come to terms with court-ordered changes to how a key value in out-of-network payment disputes is calculated.
CMS Proposes Medicare Advantage Payment Hike in 2026
The Biden administration’s last MA rule is a boon for insurers, though it remains to be seen how the incoming Trump administration might put its stamp on the regulation before it’s finalized
HHS Lays Out Strategic Plan for Healthcare AI
The agency’s road map, which outlines goals for promoting safe and equitable AI adoption, comes as the future of AI policy is uncertain under the incoming Trump administration.
44M People Enrolled in ACA Coverage Programs: KFF Study
A KFF report reveals that 44 million people gained coverage through ACA initiatives, including record marketplace enrollments and Medicaid expansion, though coverage gains may be at risk due to expiring subsidies and policy shifts.
Bonus Article
Kazakhstan Sees Incredible Progress Scaling Back World’s Worst Environmental Disaster
Just for Fun
Math Joke:
Why did the tangent line break up with the curve?
Prior Week
Q: What is a bird’s favorite type of math?
A: Owl-gebra
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