In a first-of-its-kind collaboration, Aetna, Blue Shield of California, and Centene’s Health Net have launched a shared value-based payment model aimed at enhancing primary care reimbursement and improving health equity across California.The initiative, which began on January 1, 2025, currently involves 11 provider groups and 17,000 patients, with a focus on small, independent practices. Unlike traditional models where each insurer operates separately, this single, unified payment system rewards high-quality care, particularly for underserved populations.
Author: Abhay Panchal
A bipartisan push to reverse the 2.83% Medicare payment cut that took effect on January 1, 2025, is gaining momentum, with 10 House members introducing new legislation aimed at stabilizing physician reimbursements.The Medicare Patient Access and Practice Stabilization Act proposes to roll back the payment cuts and implement a 2% increase in physician reimbursements under the Medicare Physician Fee Schedule. If passed, the bill would take effect on April 1, 2025—but will Congress act in time?Physician groups, including the American Medical Association (AMA) and the Medical Group Management Association (MGMA), warn that ongoing Medicare cuts, coupled with rising practice costs…
The healthcare landscape is undergoing a seismic shift. With staffing shortages, financial pressures, and supply chain disruptions mounting, the industry is at a crossroads. At the same time, AI, automation, and patient-driven care models are gaining momentum, promising new efficiencies and innovations.As healthcare leaders brace for another year of transformation, six emerging trends are set to reshape the way care is delivered, financed, and optimized. Some of these trends offer groundbreaking solutions, while others expose new challenges that could further strain an already fragile system.
The article “Quality Indicators for Upper GI Endoscopy,” published in The American Journal of Gastroenterology in February 2025, emphasizes the importance of photodocumentation as a key quality indicator in esophagogastroduodenoscopy (EGD). While well-established in colonoscopy, photodocumentation has recently been recommended for EGD by organizations worldwide.This recommendation aligns with broader efforts to establish quality indicators common to all gastrointestinal endoscopic procedures, as discussed in a 2024 publication in the same journal.Implementing such quality indicators is crucial for enhancing the diagnostic accuracy and overall effectiveness of EGD procedures.
Private equity (PE) is rapidly reshaping gastroenterology, with major PE-backed groups like GI Alliance, Gastro Health, and United Digestive now employing over 1,000 physicians. While consolidation efforts aimed to shift care away from high-cost health systems, new research suggests PE acquisitions may be driving prices back up.A February study in Health Affairs analyzed GI practices from 2015 to 2020, finding that after PE acquisition:
Advancements in neuroscience and digital health are reshaping the way healthcare approaches healing and well-being. In a recent discussion, Dr. Brennan Spiegel of Cedars-Sinai challenges the long-standing notion that the mind and body function independently, emphasizing the deep connection between thoughts, emotions, and physiological responses.The conversation explores vagus nerve stimulation (VNS), a promising therapy that influences relaxation, stress reduction, and disease management. With applications ranging from implanted medical devices to non-invasive consumer options, VNS is gaining attention for its ability to activate the parasympathetic nervous system, which plays a critical role in digestion, heart rate regulation, and overall well-being. Additionally,…
Could Pfizer’s latest cancer breakthrough reshape treatment for colorectal cancer? A new Phase 3 study confirms that adding Braftovi to standard therapy helps patients with BRAF V600E-mutated colorectal cancer live longer without disease progression. This follows an accelerated FDA approval in December, based on earlier data showing a significant tumor response.With BRAF mutations present in about 10% of colorectal cancer cases, the results could expand treatment options for advanced-stage patients. However, Pfizer has yet to disclose specific survival data.
For nearly 50 million Americans, seeing a gastroenterologist means driving 25 miles or more—if they can find one at all. A new Weill Cornell Medicine study, published in Gastroenterology, reveals over two-thirds of U.S. counties lack a GI specialist, disproportionately affecting rural and aging populations.
A revolutionary blood test could transform how colorectal cancer is detected—without the need for invasive procedures. Oxford BioDynamics’ (OBD) EpiSwitch® No-Stool Test (NST) has shown 81% accuracy in detecting early-stage colorectal cancer and 82% accuracy in identifying precancerous polyps, according to a new multi-center clinical study published in Cancers journal.With colorectal cancer affecting nearly 2 million people annually, early detection is critical. NST offers a minimally invasive, cost-effective alternative to traditional colonoscopy and stool-based screenings, which often lack sensitivity for early-stage disease.
A groundbreaking study suggests that a simple low-dose aspirin regimen could slash the risk of colon cancer returning by more than 50%—but only for a specific group of patients. Researchers found that 160 mg of aspirin daily dramatically reduced cancer recurrence in colon cancer patients with PI3K gene mutations, a genetic marker found in about 30% of cases. Patients taking aspirin saw their recurrence risk drop to 7.7%, compared to 14.1% with a placebo. Even more striking? Those with other PI3K mutations had a 58% lower risk of recurrence with aspirin use. Despite its potent benefits, serious side effects were…