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Mason Roberts @masonroberts.bsky.social · 2h

These advances hold immense strategic value for optimizing patient outcomes and managing population health risk.

buff.ly/Hj224ON

#NobelPrize #Immunology #HealthTech #ValueBasedCare #PrecisionMedicine

Mason Roberts @masonroberts.bsky.social · 2h

This discovery has launched the field of peripheral tolerance, directly spurring the development of critical medical treatments for cancer and autoimmune diseases.

Nobel Prize in Physiology or Medicine 2025

The Nobel Prize in Physiology or Medicine 2025 was awarded to Mary E. Brunkow, Fred Ramsdell and Shimon Sakaguchi “for their discoveries concerning peripheral immune tolerance.”

www.nobelprize.org

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Mason Roberts @masonroberts.bsky.social · 2h

This profound understanding of how the immune system is kept in check is decisive for understanding why we do not all develop serious autoimmune diseases.

For the healthcare and health tech community, this foundational rigor is paramount.

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Mason Roberts @masonroberts.bsky.social · 2h

They were honored for their discoveries concerning peripheral immune tolerance. This work identified the immune system’s critical "security guards"—the regulatory T cells—which prevent the body from attacking its own tissues.

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Mason Roberts @masonroberts.bsky.social · 2h

The Nobel Assembly's choice for the 2025 Prize in Physiology or Medicine celebrates a foundational breakthrough in health. Congratulations to Mary E. Brunkow, Fred Ramsdell, and Shimon Sakaguchi!

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Mason Roberts @masonroberts.bsky.social · 1d

Identifying potential areas for improvement and implementing necessary changes now will be critical, well before these measures affect MIPS final scores and payment adjustments. How are you preparing to leverage this in your planning?

#ValueBasedCare #ACOMSSP #HealthcareFinance

Mason Roberts @masonroberts.bsky.social · 1d

It provides a crucial grace period to truly understand performance and implement improvements before any financial consequences apply.

This stability and feedback mechanism present a vital opportunity. We encourage MSSP ACOs to proactively engage with this informational feedback.

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Mason Roberts @masonroberts.bsky.social · 1d

Additionally, CMS is proposing a 2-year informational-only feedback period for new cost measures, commencing with CY 2026. This means that clinicians, groups, virtual groups, and subgroups will receive valuable feedback on these new measures without them immediately impacting their MIPS final score.

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Mason Roberts @masonroberts.bsky.social · 1d

CMS offers continuity: the MIPS performance threshold is set to remain stable at 75 points through the CY 2028 performance period. This offers significant predictability, enabling ACOs to plan their MIPS strategies with greater confidence and refine existing quality improvement initiatives.

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Mason Roberts @masonroberts.bsky.social · 1d

For MSSP ACOs, how crucial is predictability for your strategic planning in value-based care?

The landscape for 2026 is shaping up with some welcome stability and a strategic window for adaptation.

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Mason Roberts @masonroberts.bsky.social · 1d

Will do! Thanks for bringing this up

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Mason Roberts @masonroberts.bsky.social · 2d

Blending clinical rigor with ethical context is essential to prevent the technical evaluation of risk from overriding clinical necessity.

buff.ly/fztc7iO

#EvidenceBasedMedicine #HealthPolicy #ActuarialRigor #DataScience #ValueBasedCare

Author of gender-affirming care reviews says politics are twisting his work

And other Morning Rounds health updates.

www.statnews.com

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Mason Roberts @masonroberts.bsky.social · 2d

• Evidence Assessment: Rigorous evaluation of certainty (low certainty requires caution, not prohibition).

• Values and Preferences: Defining the policy’s approach to competing values, such as avoiding harm versus valuing patient autonomy.

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Mason Roberts @masonroberts.bsky.social · 2d

This situation underscores a critical lesson for healthcare executives and policy leaders: the science of decision-making requires more than just assessing evidence. We must also explicitly account for:

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Mason Roberts @masonroberts.bsky.social · 2d

As Guyatt emphasizes, low quality evidence does not mean a treatment doesn't work; it means "we don’t know".

Yet, this uncertainty is being seized upon by opponents of certain therapies to justify bans and restrictions. Guyatt describes this use of his findings as “egregious and unconscionable”.

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Mason Roberts @masonroberts.bsky.social · 2d

Guyatt’s recent work on systematic reviews for gender-affirming care found evidence for key outcomes was of low or very low certainty. This is not unique; the majority of recommendations in clinical decision-support tools are based on weak evidence.

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Mason Roberts @masonroberts.bsky.social · 2d

A persistent challenge in healthcare is the journey from technical evidence to clinical or policy decisions. We often rely on the principles of Evidence-Based Medicine (EBM)—a term coined by Gordon Guyatt in 1991—but what happens when evidence is misconstrued?

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Mason Roberts @masonroberts.bsky.social · 3d

Actuarial rigor must be applied not just to finding savings, but to ensuring that high-value care—like home care—remains accessible to those who need it most, even amid budget pressures.

Link in the comments

#Medicaid #HealthPolicy #ActuarialRigor #IDDCare #ValueBasedCare

Mason Roberts @masonroberts.bsky.social · 3d

3. Actuarial Rigor in Policy: Policy discussions must move beyond simple cost cutting to adopt predictive models that account for the unique, lifelong service needs of the I/DD population to ensure sustainable and ethical management of high-cost cohorts.

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Mason Roberts @masonroberts.bsky.social · 3d

2. Transition Risk: While 82% of nonelderly Medicaid enrollees with I/DD are children (0-18), they frequently face barriers maintaining coverage and accessing essential services when they age out of child eligibility pathways and lose critical benefits like EPSDT.

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Mason Roberts @masonroberts.bsky.social · 3d

1. Unmet Need as Future Cost: Nearly three-quarters (73%) of the total Medicaid home care waiver waiting list population—approximately 521,000 people—have I/DD. These waiting lists represent massive unmet needs that often compound future costs if not addressed.

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Mason Roberts @masonroberts.bsky.social · 3d

These costs reflect high health care needs, chronic conditions, and critical reliance on long-term home care.

For healthcare executives and actuaries focused on risk stratification, the data highlights three critical financial and access challenges:

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Mason Roberts @masonroberts.bsky.social · 3d

How do we quantify risk and manage costs for a population where the financial reality is so stark?

Medicaid spending for enrollees with I/DD is dramatically higher: annual per capita spending is four times greater for children (<19) and seven times greater for adults compared to those without I/DD

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Mason Roberts @masonroberts.bsky.social · 3d

The projected $911 billion reduction in federal Medicaid spending over the next decade puts immense pressure on states to reduce costs, disproportionately threatening coverage for people with Intellectual and Developmental Disabilities (I/DD).

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Mason Roberts @masonroberts.bsky.social · 6d

It'll be interesting to see who adapts and how long it takes them. It's knowable right now if you stand to lose in this program but my guess is many systems are dealing with other fires.