A Call for Reform: Fraud, Waste & Abuse in Medicare Requires Sweeping Action
Medicare must modernize fraud detection using advanced analytics, streamline resolution processes, and align oversight with value-based care goals to ensure sustainability.
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.
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.
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.
Pearl Health achieves HITRUST r2 Certification, demonstrating its commitment to the highest standards of data security, compliance, and risk management.
Value-based care confusion, policy uncertainty, and AI integration dominated RIPCC 2025. Primary care providers seek guidance, education, and strategic support to navigate evolving healthcare challenges.
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.
Pearl Health fosters a thriving workplace through engagement, inclusivity, work-life balance, and professional growth—empowering teams to deliver proactive, patient-centered care.
Latest DeepScribe partnership brings AI documentation and point-of-care intelligence to primary care clinicians participating in ACO REACH and other risk-bearing models
Virginia Care Partners and Pearl Health partner to expand value-based care in Richmond, providing technology, insights, and financial tools for primary care providers.
Pearl Health appoints Dennis Weaver, MD, MBA, as Chief Clinical Officer to advance value-based care, clinical leadership, and healthcare innovation partnerships.
America’s Physicians Group Fall Conference 2024 spotlighted capitation, proactive adaptation, and team-based care as key drivers of healthcare’s value-based future.
Holzer Health System and Pearl Health have partnered to enhance patient-centered care for Medicare patients through advanced data insights, financial tools, and provider enablement technology.
David Junius joins Pearl Health as CFO, enhancing risk management expertise to advance value-based care.
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.
Gabe Drapos chats with Rubicon Founders’ Abe Sutton and explores Medicare Advantage payments, health status impacts, and reforms for a fairer system.
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).
Synapticure partners with Pearl Health, enhancing dementia care through telemedicine, neurologists, caregiver support, and value-based integration.
Synapticure and Pearl Health partner to enhance dementia care through the CMS GUIDE program, offering specialized neurologists, behavioral health support, and comprehensive caregiver services nationwide.
Pearl Health partners with PraxisCare and Adaugeo Healthcare Solutions to enhance value-based care for Medicare ACOs, leveraging cutting-edge technology to improve patient outcomes.
Pearl Health partners with MDX Hawaiʻi to enhance primary care in Hawaii, providing data insights, financial tools, and value-based services for better patient outcomes and lower costs.
Pearl Health CEO Mike Kopko chats with Faisel and Friends and highlights value-based care’s role in reducing costs, improving outcomes, and easing physician workload through patient-centered strategies and digital innovation.
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.
Today begins Pearl’s Drive for Better Care, a two-week journey to connect with primary care practices nationwide.
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.
Jennifer Rabiner, Pearl Health’s CPO, shares insights with Pear VC on improving primary care workflows and upcoming partnerships.
In May and June, the Pearl Health team is driving from New York to Miami, with detours to visit primary care practices in 10 other major cities. We’re committed to raising the voices of primary care providers across the country. We know the obstacles they are facing on the road to delivering better care. That’s why we’re hitting the road ourselves to meet them where they are.
A data-driven, inference-based RAF model could improve Medicare cost accuracy, reduce bias, and streamline administration.
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.
Jonathan E. Goldin, Chief Legal Officer at Pearl Health, was one of 35 honorees named to Crain’s New York Business 2024 Notable General Counsel list. The list recognizes exceptional in-house lawyers across a variety of industries and includes individuals guiding health care innovators, steering organizations through regulatory landscapes, and supporting marginalized groups, such as defrauded immigrants.
NEW YORK (February 6, 2024) — Pearl Health today announced that it has been named to the 2024 New York Digital Health 100 (DH100), a recognition that highlights the most exciting and innovative startups in New York. Digital Health New York (DHNY) publishes the annual list in conjunction with the New York Healthcare Innovation Report, which takes an in-depth look at the investment trends, opportunities and challenges in the digital health sector.
AI and technology reshape healthcare by improving value-based care, personalizing experiences, and reducing inefficiencies.
Hospitals must shift to value-based care, decentralize, and embrace virtual solutions to ensure sustainability and public value.
Michael Kopko, CEO of Pearl Health, highlights the role of value-based care in improving patient outcomes through proactive, data-driven strategies, stressing the importance of collaboration and partnerships for success.
Walgreens partners with Pearl Health to enhance primary care through value-based care and data-driven insights.
This podcast from Race to Value explores how primary care enablement can make healthcare more accessible and affordable.
Pearl Health CEO Michael Kopko and COO Gabe Drapos discuss navigating value-based care options, like ACO REACH and Making Care Primary, while leveraging Pearl’s platform to enhance patient-centric care.
This article, published in Health Affairs, critiques value-based care, emphasizing the need for proactive care models like ACO REACH, while addressing concerns about consolidation and regulatory advancements to promote competition and reduce healthcare costs.
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.
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.
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
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
The Centers for Medicare and Medicaid Innovation Center (CMMI) is hosting a listening session to discuss its October 2021 whitepaper, “Driving Health System Transformation –
(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
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