Deep dives into topics in healthcare
We explain CMS’s new Advanced Primary Care Management (APCM) model, which expands care management access, simplifies billing, and supports proactive, patient-centered care—empowering PCPs with flexible, scalable tools and technology-driven solutions.
We explain CMS’s new Advanced Primary Care Management (APCM) model, which expands care management access, simplifies billing, and supports proactive, patient-centered care—empowering PCPs with flexible, scalable tools and technology-driven solutions.
At a recent Lunch & Learn at Pearl, Sid Sankaran shared insights on risk, resilience, and reinvention, urging teams to foster transparency, prioritize focus, align incentives, and embrace antifragility.
Catherine Naughton, Director of People & Recruiting at Pearl Health, shares her journey from education to tech, what drew her to Pearl, and how she’s helping shape a values-driven company culture rooted in impact.
The 2025 NAACOS Spring Conference emphasized the urgency of evolving value-based care through localized models, operational simplicity, AI integration, actuarial strategy, and holistic behavioral and specialty care inclusion.
Pearl Health’s last Primary Care Pulse report revealed high burnout and low compensation, but value-based care showed promise—adding your voice in 2025 can help shape a stronger future for primary care.
In this Employee Spotlight, Ben Csukor of Pearl Health’s Performance Operations team shares how his work helps fill critical gaps between technology and care delivery — supporting providers, improving patient outcomes, and finding meaning in the details behind the scenes.
We explore evolving federal regulations on healthcare AI, emphasizing the shift from predictive vs. evidence-based distinctions to a provider-focused framework that prioritizes enablement over displacement in clinical decision-making.
Medicare must modernize fraud detection using advanced analytics, streamline resolution processes, and align oversight with value-based care goals to ensure sustainability.
CMMI’s recent model changes reflect a strategic shift toward scalable, full-risk payment models—reinforcing value-based care, fiscal discipline, provider accountability, and a more integrated, sustainable healthcare delivery system.
Computer Use Agents (CUAs) enable AI to interact with desktop applications, offering potential benefits for tasks like EHR integration, but require strict safeguards for HIPAA compliance and patient data security.
Massachusetts family physicians explored advancements in patient care, AI integration, chronic disease management, and healthcare equity at the 2025 Massachusetts Academy of Family Physicians Conference.
In this Employee Spotlight, Madison Klein, Head of Marketing at Pearl Health, reflects on how the company has evolved, the power of storytelling in healthcare, and why Pearl remains a safe harbor for curious, mission-driven thinkers.
Skilled Nursing Facilities are vital for recovery, but misaligned Medicare incentives can lead to unnecessary stays, higher costs, and worse patient outcomes.
Learn how physician-led organizations can evaluate value-based care partners—and how Pearl empowers primary care to thrive in a changing healthcare landscape.
Get to know Sophie Bennett, a key member of Pearl Health’s Growth Solutions team. In this employee spotlight, Sophie shares how she helps bridge strategy and relationships to craft thoughtful, data-driven proposals — and how curiosity, collaboration, and a little behind-the-scenes magic shape her work.
AI is poised to solve healthcare’s toughest challenges—interoperability, burnout, access—accelerating real change. With Pearl, we’re making it happen.
Pearl Health is enhancing sepsis prevention by helping primary care physicians adopt Sepsis-3 criteria, reducing overdiagnosis from Sepsis-2, improving patient outcomes, and lowering unnecessary Medicare costs through predictive analytics and proactive interventions.
We’re proud of our progress on this mission over the past year and excited to continue accelerating healthcare’s transition from volume to value. Read some of our highlights from 2024 as we head into the new year. Cheers!
Learn how Pearl Health’s predictive insights reduced ED visits, improved chronic care, and empowered patient-provider relationships.
See how Pearl Health’s predictive technology empowers PCPs to proactively manage high-risk patients, preventing costly unplanned hospital admissions.
America’s Physicians Group Fall Conference 2024 spotlighted capitation, proactive adaptation, and team-based care as key drivers of healthcare’s value-based future.
Pearl Health helps primary care physicians navigate value-based care models. This article explores future changes under a second Trump administration, and their impact on healthcare costs, patient outcomes, and Medicare sustainability.
At the Innovations in Value-Based Care Conference 2024, Pearl Health leaders discussed the enduring commitment to value-based care, enhancing patient outcomes, and the need for unified efforts across healthcare stakeholders.
Medicare fraud costs billions annually, impacting beneficiaries and providers. Pearl Health suggests three levers for swift action: streamlined reporting, faster resolution, and reinsurance reform to combat fraud, waste, and abuse (FWA).
CMS’s 2025 Medicare Physician Fee Schedule proposal aims to advance value-based care but includes a 2.8% reimbursement cut, sparking industry-wide concern over financial viability and calling for comprehensive reform.
Our healthcare system is undergoing a revolution towards patient-centric care, shifting from volume to value-based care models, emphasizing holistic patient engagement and proactive health management.
The August 1st enrollment deadline for participating in Medicare’s ACO REACH Model in 2025 is rapidly approaching. To help answer questions for those considering participation, on July 11th, Pearl hosted a free informational webinar on ACO REACH.
We stopped in Orlando to meet Brent Davis of AdventHealth, who discussed with us transitioning to value-based care, crafting risk strategies, and the integral whole-person care ethos driving their system’s success.
As we made our way through Washington, D.C. on Pearl Health’s Drive for Better Care, we enjoyed the opportunity to meet with Mara McDermott, CEO and Founder of Accountable for Health, Board Member at the Health Care Cost Institute, and one of Pearl Health’s Top 50 Value-Based Care Thinkers of 2023.
As part of Pearl Health’s Drive for Better Care, we recently had a chance to sit down with Dr. Lee Fleisher, Principal and Founder at Rubrum Advising, Former Chief Medical Officer for the Centers for Medicare & Medicaid Services, and one of Pearl Health’s Top 50 Value-Based Care Thinkers of 2024.
Through the approach of Conduce’s marketplace and two product offerings — Clinical Profiles and the Referral Engine — Conduce Health and Pearl Health have launched a unique partnership in South Carolina to tackle the needs of complex, polychronic patients and the network of physicians managing their care
Toward the end of our inaugural Drive for Better Care, we stopped in Atlanta to meet with Yubin Park, CEO of Mimi Labs and formally Chief Data and Analytics Officer at Astrana Health, a leading provider-centric, technology-powered healthcare company, and one of Pearl’s Top 50 Value-Based Care Thinkers of 2024.
As part of Pearl Health’s Drive for Better Care, we recently had a chance to sit down with Dr. David B. Nash, Founding Dean Emeritus at Jefferson College of Population Health and one of Pearl Health’s Top 50 Value-Based Care Thinkers of 2024. A board-certified internist, Dr. Nash is internationally recognized for his work in public accountability for outcomes, physician leadership development, and quality-of-care improvement.
By 2030, CMS aims for all Traditional Medicare beneficiaries to be in accountable care relationships, with 50% already under Accountable Care Organizations. Primary care providers increasingly adopt value-based care models for better outcomes and rewards.
As we guide primary care providers (PCPs) through the transition to value-based care, one question frequently arises: how exactly does Pearl’s technology integrate with existing Electronic Health Record (EHR) systems? It’s an important question worth exploring. In this article, we’ll dive into how EHRs and the Pearl Platform fit into a practice’s workflow, and our ongoing work to enhance Pearl insights for PCPs through seamless EHR integration.
Are you a PCP? Share Your Experiences in the Primary Care Pulse! We’re always looking for ways to better understand the challenges and pressures that PCPs face in navigating the clinical, administrative, and financial realities of US healthcare.
In the realm of MSK health, patients often face agonizing journeys. Surgical interventions, despite repeated attempts, leave them in discomfort, burdened with astronomical bills. We advocate for responsible, evidence-based care, prioritizing patient involvement and noninvasive approaches, shifting the paradigm towards holistic healing and shared decision-making.
The newest value-based care model from the Center for Medicare and Medicaid Innovation (CMMI), ACO REACH, aims to improve clinical outcomes and reduce Total Cost of Care (TCOC). Providers are incentivized to deliver the best care to their Traditional Medicare patients, while achieving economic efficiencies that are critical to an overburdened Medicare trust fund. One feature of this program — Voluntary Alignment — can empower patients to play a larger role in their own health, while enhancing physicians’ ability to manage their panels and grow their practices.
If primary care’s time has come, why doesn’t it feel like it? That’s one question we explored in Pearl’s 2023 Primary Care Pulse Report. After collecting survey responses from more than 200 physicians, conducting follow-up interviews, and exploring secondary research, we learned a great deal about the challenges PCPs face in today’s healthcare system. We explored one challenge, the epidemic of PCP burnout, in a recent blog post, and today will dive into another — physician pay.
There’s no avoiding a simple fact: primary care physicians (PCPs) are struggling. The majority — whether in small group practices or large multispecialty organizations — feel overworked, under-resourced, and inadequately rewarded in their efforts to provide quality care.
CMS’ ACO REACH model simplifies quality measurement for providers participating in the Medicare Shared Savings Program (MSSP). Reporting burden is reduced, freeing providers to focus on patient care.
With the right partners, Medicare’s upcoming Guiding an Improved Dementia Experience (GUIDE) model has the potential to transform dementia care for patients and caregivers.
We’re proud of our progress on this mission over the past year and excited to continue accelerating healthcare’s transition from volume to value. Read some of our highlights from 2023 as we head into the new year. Cheers!
Discover how Pearl Health’s predictive analytics and Signal-Action Framework help identify patients at risk for preventable ED visits, enabling primary care providers to take proactive steps and ensure care is delivered in the most appropriate setting
Explore how Pearl Health’s new predictive algorithm identifies Medicare beneficiaries with multiple chronic conditions at risk for unplanned hospital admissions, enabling proactive, well-coordinated care for improved outcomes.
Nominate leaders shaping the future of healthcare! Pearl Health opens nominations for the Top 50 Value-Based Care Thinkers 2024. Celebrate innovators driving transformative change in healthcare delivery and reimbursement.
Join Lauren Prial, Head of Performance Operations at Pearl Health, in a candid conversation about the company’s unwavering values and the pivotal role employees play in its success. Discover how Pearl addresses the complexities of value-based care, supports primary care practices, and tackles challenges to create a patient-centric healthcare model.
April Greene, a seasoned healthcare strategy and operations executive, joins Pearl as Senior Vice President of Medicare Advantage. April joins Pearl with more than 25 years of experience in healthcare, offering expertise across network and clinical operations, value-based care, and population health.
Pearl Health published its 2023 Primary Care Pulse Report today, which identifies primary care challenges and opportunities based on survey responses from 200+ PCPs, follow-up interviews, and secondary research.
Explore how Accountable Care Organizations (ACOs) are revolutionizing healthcare, with a focus on value-based care, data science, and patient-centric approaches. Learn about the future of healthcare in 2030.
When patients leave the hospital, their journey to recovery is far from over. In fact, it’s during this crucial transitional period that they’re most vulnerable to complications and setbacks that can lead to unplanned readmissions, higher mortality rates, and unnecessary health care costs.
Pearl is excited to equip PCPs with cutting-edge data science, to predict future preventable ED visits.
As healthcare moves toward value-based care, negotiating contracts that are provider-friendly and mutually beneficial has become increasingly important — and increasingly difficult.
Healthcare’s shift to value won’t happen because of wishful thinking or hopeful platitudes. Read on for Bill Georges’ perspective on the hard truths we need to recognize and face to succeed in value-based care.
Learn how to set your medical practice up for success in 2024 with the ACO REACH model. Discover key features, modifiable variables, and tips for preparation. Don’t miss the opportunity to embrace value-based care and increase revenue.
Discover how Pearl Health meets primary care physicians (PCPs) where they are, addressing their concerns and offering financial opportunities through the ACO REACH model. Learn about primary care capitation, risk-based arrangements, and revenue enhancements to maximize revenue and support PCPs in delivering quality care.
As primary care practices navigate the choices offered by ACO REACH, they encounter an important factor to consider within the Global program: the Performance Year
The US healthcare system has long struggled to identify a fair and efficient reimbursement scheme that aligns the incentives of patients, providers, and payers. In this article, Pearl Health recognizes the Top 50 Value-Based Care Thinkers of 2023 and discusses the biggest themes, news, and trends driving evolution and innovation in value-based care, including physician enablement and data interoperability.
Advance Care Planning is a process that helps patients share their personal values, life goals, and preferences regarding future medical care, while offering numerous benefits for both patients and clinicians.
Enhance the efficiency and quality of primary care with our pre-visit planning solution. Learn about the various domains, best practices, and technology available to streamline processes and provide better patient care.
Discover the importance of having an incident policy in place at Pearl Health. Learn about the process, criteria, and SLAs involved in handling critical issues, and how it helps keep the company’s technology and patient data safe. Read now to learn more.
We are proud to announce that we have raised $75 million in our Series B funding round, led by Andreessen Horowitz’s Growth Fund and Viking Global Investors, with follow-on funding from AlleyCorp, SV Angel’s Growth Fund, and other leading investors.
It’s been a year of extraordinary growth and development for Pearl Health and value-based care. Read some of our highlights from 2022 as we head into the new year. Cheers!
Risk prediction models are incredibly useful tools that recognize the underlying patterns common to patients who will go on to become HCHN.
If you’re a PCP joining a REACH ACO in 2023, there is a lot to comprehend about how capitation will impact your monthly revenue in advance of the January 1st start date. In this post, we will address providers’ most Frequently Asked Questions regarding BPCC with the goal of empowering PCPs to take advantage of capitation in the new REACH ACO model.
Medicare’s future is linked to the success of the US and will be a harbinger for health systems across the world. Here are six predictions.
When you visit your doctor, chances are you could pay a copay or coinsurance bill with a credit card saved on your smart watch. Odds
The Centers for Medicare & Medicaid Services (CMS) announced that Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program saved Medicare — and US
Primary care providers (PCPs) in the US are burdened with administrative tasks and under-compensation, impacting downstream healthcare costs. The limitations of existing value-based care models creates an opportunity to explore the potential of Specialty Risk Partners (SRPs), mission-driven companies managing distinct patient cohorts based on clinical disease burdens. Pearl Health proposes a risk marketplace to enable physician-led healthcare, by aligning PCPs with SRPs through financial incentives to improve healthcare outcomes and benefit all parties involved.
There are distinct eras in the development of the modern American healthcare payments system. Pre-Insurance Period (Pre-1942): The period prior to World War II involved
What does it take to build a patient-centric brand? Discover the key drivers of an effective brand strategy for your primary care practice.
At Pearl, we focus on empowering our physicians and our community to extend the quality and length of human life through preventative, patient-focused care.
At Pearl, we focus on empowering our physicians and our community to extend the quality and length of human life through preventative, patient-focused care.
For your practice to provide quality care and enjoy long term success in an ACO, we focus on two key levers impacting your shared savings
At Pearl, we recognize the need to embed compliance in everything we do from the onset. We’re hitting the ground running on our path to becoming HITRUST certified.
The U.S. Conference of Mayors voted in support of the CMS’s ACO REACH Model, recognizing the model’s potential to increase primary care availability in underserved communities and bridge historic health inequities
As we move into the third year of the pandemic, what has become plain is the importance of healthcare data as a public good.
As a primary care provider, you may be wondering what portion of your FFS revenue can be attributed to E&M services. Here, we break down total FFS revenue along various dimensions for you.
In Part 3, we continue to examine how value-based organizations can support primary care providers in managing the care journeys of their patients.
By removing certain risk factors in your life, you can statistically extend it. Data studied from more than 8,000 patients found that managing these risk factors well can extend life by approximately 9 years.
The ACO REACH program has many fewer Quality Measures (QMs) than past ACO programs did. Here’s a breakdown of the four QMs and our perspective on how to succeed.
From our experience helping primary care practices transition to value-based care, we know that delivering high-quality care while controlling costs is about more than simply aligning payments with value — that is just the beginning.
In Part I of the Value-Based Care Playbook, we ensured a shared understanding of the notion of Value in the context of healthcare. Here, we
2022 is poised to be a big year for value-based care (VBC). The Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare
Much ink has been spilled on the Centers for Medicare and Medicaid Services (CMS) value-based care pilot known as Direct Contracting (see: Washington Post OpEd,
2021 Pearl Health Year-In-Review Milestones Primary Care Trends Resolutions Looking Back Trends Resolutions Looking Back: A Pearl Is Formed This past year marked the first full year
Part 1: Defining Value in Healthcare Value-based care, a term largely attributed to Michael Porter and Elizabeth Teisberg, is the idea of structuring incentives to
As we approach another Medicare ACO performance year, now in the REACH model as opposed to Direct Contracting, we’ve refreshed our FAQ article from last
The Centers for Medicare and Medicaid Innovation Center (CMMI) is hosting a listening session to discuss its October 2021 whitepaper, “Driving Health System Transformation –
Value-based care programs have never been simple, and Direct Contracting is no different. Nonetheless, understanding how Direct Contracting works is critical to succeeding in the
In the same way that there has been tremendous evolution in value-based models in the past decade, the way in which we access and use
(Healthcare) Risk Is Opportunity The slogan for the Society of Actuaries is “Risk is Opportunity.” As providers consider managing healthcare risk through value-based models, they
Last week I had the privilege of joining the inaugural meeting of Pearl Health’s Anchor Partner Program to hear from some of our new partners:
A colleague recently sent me this video (referenced in this post’s title) over Slack. “Many misconceptions in here,” he said. To put it lightly.
Medicare may be one of the best healthcare markets for value based care models. The below arguments lay out why further investments in value based
With the advent of the COVID-19 pandemic, many ACOs who had enrolled in program models prior to the pandemic were stuck feeling uncertain about the
I am a physician and I am not satisfied with my electronic medical record system. This is unfortunately not a unique or interesting statement: the
Primary Care Physicians (PCPs) make up the lion’s share of the medical workforce and are the main point of contact to the healthcare system for
Running a physician practice inevitably means two distinct and often orthogonal challenges: taking care of patients and managing the “business” side of the practice. A
Value-based care has been part of our healthcare lexicon for the last 15 years when, in 2006, Michael Porter and Elizabeth Olmsted Teisberg are credited
We’ve been lucky to meet and speak with some of the great minds in healthcare as we built Pearl Health and through our time scaling
Source We all have some level of reliance on Medicare. Whether you’re retired and on the program, about to move into benefits in the coming
Pearl Health believes that understanding the likely path of healthcare reform is critical for providers and payers alike to position themselves for success in the
