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Reposted by Mason Roberts

Bradley @bradleyross.bsky.social · 08/07/2026

Public stadium financing is a scam. youtube.com/shorts/ACL-4...

youtube.com

Are sports stadium subsidies a scam?

YouTube video by Alex Falcone

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Mason Roberts @masonroberts.bsky.social · 06/07/2026

And still probably the highest of the OECD countries

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

It’s the same population Boulder's affordable housing shortage most directly affects. Planning Boards don't typically think of themselves as health policy actors, but they should. #AffordableHousing #SocialDeterminantsOfHealth #Medicaid #ValueBasedCare #HealthEquity

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

Effect wasn't just short-term noise. Costs kept declining from 6 to 12 months, suggesting durable impact. We have an epidemic in our country of unstably housed adults with depression, anxiety, substance use disorders, the same folks this program targets.

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

-- $3,260 lower per-person health care costs vs. comparison group -- 36% reduction in hospital readmissions -- 5% reduction in ED visits -- n = 6,575 which is the largest study of its kind to date

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

A recent study on Massachusetts’s MassHealth's Flexible Services Program makes that case in dollar terms. Key findings at 12 months:

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Mason Roberts @masonroberts.bsky.social · 29/04/2026

Housing is a human right, and it is a win-win in terms of costs to society. I see this in study after study (check Health Affairs articles on housing) and I see it on the ground in my work as an appointed Boulder official.

Pinwheel graphic titled "The Economic Benefits of Affordable Housing" with six segments: Reduced Healthcare Costs (lower expenses for individuals and society), Decreased Hospital Readmissions (fewer patients returning to the hospital), Lower Emergency Department Visits (reduced reliance on emergency services), Durable Impact (long-term positive effects on health and well-being), Addressing Mental Health (support for individuals with depression and anxiety), and Community Planning (integration of housing into health policies). The Reduced Healthcare Costs and Decreased Hospital Readmissions segments are highlighted in blue.

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

LEAD needs to preserve that signal. These items are important for REACH’s population health thesis. IDK - Will LEAD build on REACH's equity and complexity infrastructure or start over? I’ll be watching. #CMMI #ValueBasedCare #LEAD #HealthEquity

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

the health equity infrastructure is in question. Equity plans, HE benchmark adjustment, etc., it’s unclear how much carries forward, and given this administrations kneejerk reaction to anything with the “e” word in it worries me. REACH showed equity-focused design can work financially;

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

complexity <> risk when benchmarks are calibrated right CMS is replacing REACH with the LEAD Model (launching 2027). LEAD drops the capitation structure so we’re back to shared savings with prospective assignment. The pricing mechanics make a whole lot more sense, but

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

-- 132 ACOs, 2M+ Medicare beneficiaries in first performance year (2023) -- 88% of eligible ACOs met CI/SEP quality thresholds -- 74% spent below benchmark; average gross savings rate of 7% -- High-needs ACOs drove disproportionate savings (17% vs. 5% for standard):

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Mason Roberts @masonroberts.bsky.social · 28/04/2026

REACH was wildly successful and there’s even higher hopes for LEAD. Here’s what was achieved:

A pros and cons graphic titled "LEAD Model" on a dark background. Pros listed on the left in blue: shared savings, prospective assignment, sensible pricing. Cons listed on the right in purple: equity concerns, infrastructure uncertainty, political risk. A central icon shows two figures with checkmark and X symbols above them.

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

I’m hopeful that these changes will reward the provider groups focused on the right things. Risk scores are still projected to increase around 3%, but the winners and losers will be split by chart review dependency, not quality. #MedicareAdvantage #HealthcareFinance #ValueBasedCare #RiskAdjustment

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

These are major shifts, but on the whole there’s only one of these that I don’t like. I’ll let you guess which one that is.

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

Star Ratings 1) Removing 12 (mostly administrative) measures from Star Ratings. 2) Health Equity Index reward being eliminated before it ever launched. 3) Historical reward factor reinstated which will likely favor incumbents, not improvers

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

Risk adjustment 1) Update training data from 2018–19 to 2023–24, which will mean a shift in coefficients. 2) Removing “unlinked” charts reviews from the calculation.

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Mason Roberts @masonroberts.bsky.social · 07/04/2026

Your payer partners' financial pressure is your contract pressure. CMS is proposing some major shake-ups in MA for risk adjustment and Stars. Here’s a quick summary for both. For providers in VBC deals, this is going to directly impact the terms of your contracts.

Dual-arrow diagram titled "Navigating MA Changes for Contract Success." Left arrow (blue, risk adjustment): Training Data Update — shift in coefficients; Unlinked Chart Reviews — removed from calculation. Right arrow (gray, Star Ratings): Measure Removal — administrative measures dropped; Health Equity Index — reward eliminated; Historical Reward Factor — favors incumbents.

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

The rate book transition (timing depends on your region) is designed to lock in that wedge as a permanent feature of regional benchmarks rather than letting it collapse as the ACPT catches up to realized savings. #ValueBasedCare #ACO #CMMI #HealthPolicy #REACH #LEAD RFA: buff.ly/BwXrHfw

buff.ly

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

1) The ACPT (trending benchmarks above realized spending when ACOs slow growth) 2) The benchmark add-ons (1.5% admin add-on for higher-spenders; regional efficiency adjustment for lower-spenders)

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

CMS is explicitly targeting 3% savings between average benchmarks and average actual claims by year 5, mainly engineered through two levers:

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

Higher-spending ACOs get room to improve; lower-spending ACOs get a stable floor and both have an incentive to stay. How do they accomplish this? Well, it’s complicated, but here’s the TL:DR

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

LEAD is taking a “wedge” approach instead of the REACH rebasing which punished those who did exceptionally well (do better, get a tougher target). LEAD benchmarks are set above observed expenditures but below projected FFS growth, creating a durable shared savings corridor.

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

Let’s get a little deeper if you’ve got time. Benchmarking.

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

Duals - your highest cost patients. LEAD includes a planning phase to develop Medicare-Medicaid partnership arrangements with select states Those were my top three. There’s other improvements that shows CMMI is actively learning and listening, finding ways to improve their programs.

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Mason Roberts @masonroberts.bsky.social · 02/04/2026

LEAD vs. REACH: What's actually new. No pussyfooting around - let’s get right to it. Benchmarking - This one is pretty huge. No more rebasing. Specialists - LEAD has built-in infrastructure for downstream episode-based risk between ACOs and Preferred Provider specialists (CARA)

Podium-style infographic titled "LEAD Program Innovations" showing three medal placements. First place: Benchmarking — durable shared savings corridor with stable floor and incentive to stay. Second place: Specialists — built-in infrastructure for downstream episode-based risk between ACOs and specialists. Third place: Duals — planning phase for Medicare-Medicaid partnership arrangements with select states.

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

survey-based trajectory measures could capture something that the data misses; a fragmented diagnostic journey. How else do you measure what didn’t happen? I’m interested in hearing your perspective. Are you using quality measures in your VBC deals? Which ones do you rely on?

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

4) Adverse selection incentives - if groups are judged on outcomes, the rational response is to avoid attributing high-risk patients, not to serve them better I like process measures. They’re easy to understand and create from data. But...

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

3) Risk adjustment inadequacy - outcomes measures without near-perfect risk adjustment systematically punish providers serving sicker, poorer, more complex populations; this is the same equity critique leveled at Stars

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

2) Attribution ambiguity - for complex chronic conditions, which provider or group gets credit or blame for a 5-year outcome? MS progression is influenced by genetics, socioeconomics, prior treatment, and care quality simultaneously

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

I’m tempted to be purest - use data, use outcomes - but there are some benefits to some surveys that can’t be ignored: 1) Attribution lag - many meaningful outcomes (disease progression, mortality, quality of life over a decade) take years to manifest; payment cycles don't wait

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

Well, first, we can move towards more outcomes measure based quality metrics. But, as Renu Xu argues, we can move towards trajectory measures. For example: diagnostic velocity would help to assess the efficiency of a patient’s path from first evaluation of symptoms to a correct diagnosis.

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Mason Roberts @masonroberts.bsky.social · 01/04/2026

Patient reported surveys just don’t cut it. -- Response rates are low -- They’re biased towards more privileged patients -- And they’re often gamed (see my last post) So what to do about it?

A balanced scale diagram titled "Balancing Outcomes and Surveys in Value-Based Care," showing Outcomes Measures on the left pan weighted down by Attribution Lag and Risk Adjustment Inadequacy, and Survey-Based Measures on the right pan weighted down by Attribution Ambiguity and Adverse Selection Incentives.

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

-- Eliminating the EHO4All reward leaves a real policy gap. Plans serving vulnerable populations consistently score lower — bring it back. So next time comments become available, let’s push for this. Maybe we can better align these incentives towards the outcomes we all want. #MedicareAdvantage

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

-- Move prior auth practices, provider payment patterns, marketing, and encounter data completeness off Stars and into a standalone MA Transparency Scorecard -- Congress needs to make the QBP budget-neutral. CMS can't do it alone through rulemaking

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

-- Narrow Star Ratings to outcomes, population health, and patient-reported experience measures -- Shift to plan-level scoring so beneficiaries can compare options in their actual county

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

I was reading a Health Affairs article on just this and I liked their recommendations. I’d summarize it as “Better Stars + an MA Transparency Scorecard”. buff.ly/XT7h1cw Here’s what they proposed:

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

$87B in bonus payments since 2015, with no budget-neutrality requirement unlike other Medicare quality programs (e.g. risk adjustment). So what do we do about it?

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

Currently, the Star rating program rewards the wrong things. There’s 40+ measure across 9 domains and they are overweighted toward process metrics and administrative indicators. So, what do you get? Better documentation, not care delivery. And it’s expensive.

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Mason Roberts @masonroberts.bsky.social · 31/03/2026

One of the major challenges i see repeatedly in my world is it’s extremely difficult to align incentives with outcomes. Here’s an example from the Medicare Advantage space, the Star ratings.

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

you do need to be ready to adapt and learn to shift along with the changing systems. #HealthcareAI #HealthcareWorkforce #ValueBasedCare #HealthcareInnovation #HealthcareLeadership buff.ly/tHrAyzZ

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

If you’re super good at planning out a project and writing prompts, you can create personalized software. So, if you’re worried about your job prospects, it’s time to get AI literate. You don’t need to be a coding wiz or the person volunteering for the pilot, but

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

You’re seeing a parallel even amongst those directly using AI. The skills you need aren’t necessarily coding (although it definitely helps) but rather better communication and problem solving skills.

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

“I do, however, think we’ll see duties shift. I think we’ll see positions move from ‘back end’ to ‘front end.’ We’ll focus more on patient experience, human connections, and interpersonal relationships,” Will Landry, senior vice president and CIO of Baton Rouge, La.-based FMOL Health.

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

I was reading interviews from healthcare CIOs and they had some other interesting insights. Once being that health systems adding AI tools are still net hiring. The question is what skills they're hiring for.

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Mason Roberts @masonroberts.bsky.social · 26/03/2026

“AI won’t take your job. Someone using AI will.” I’m sure you’ve heard this before, but it’s not completely true. What we’re seeing in health care is that reliance on human connection insulates many from mass AI-driven job loss. What’s really happening is a role shift.

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Mason Roberts @masonroberts.bsky.social · 25/03/2026

Overview - buff.ly/0f20C5d List of measures - buff.ly/fmBr4V9 List of participants - buff.ly/ksfFSUX

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Mason Roberts @masonroberts.bsky.social · 25/03/2026

You’re going to start being more aware of how your peers are doing which will motivate some to do better. Here’s a few resources if you want to know more, including a list of the specialists selected for the program.

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Mason Roberts @masonroberts.bsky.social · 25/03/2026

My hot take - these specialists have likely already been participating in MIPS given the specialist selection criteria so nothing new there. However, this is going to be like that electricity bill you get about your neighbors.

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Mason Roberts @masonroberts.bsky.social · 25/03/2026

— The model uses a two-sides risk arrangement, so there is real financial risk — Your performance is benchmarked against your peers — The quality measures include are your standard MIPS measures for these conditions

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