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Clapping Audience

​Intelligence Brief: High-Value FFS Toolkit Part 1

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In this Part 1 of a three-part series, we explore high value FFS codes to support enhanced care management services, detailing eligibility and service requirements, billing and best practices.

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What's New

What's New In Health Endeavors 

Stay up-to-date with the latest enhancement and feature updates. 

2025 Analytical Data 

2025 analytic data is now live on your dashboard and fully integrated into all the quick reports. Your benchmarking is powered by the most recent CMS-published data—tailored specifically to your ACO.

 

Keep in mind that benchmarks are updated only when CMS releases the Aggregate Expenditure/Utilization Reports (EXPU). 

 

To ensure a clear matching of data to benchmarking to 2025 data, the benchmarks will be blank until the EXPUs are published for 2025. 

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As the claims line feeds are received, the diagnosis recapture will populate and update, providing that crucial recapture rate along with the average 2025 AVG HCC Score. 

Release Date: 3.12.2025

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Quick Reports

HCC Details and Summary Report   

We are excited to announce a new HCC Details and Summary quick report, designed to enhance visibility into performance in preparation for the transition to full v28. 

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Purpose: This new report retains the detailed diagnosis-level HCC insights, while expanding to include summary-level views at the patient, NPI and TIN levels.  A major enhancement includes identifying HCCs that are potentially co-managed by specialists providing visibility into shared care responsibility. 

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The Importance: This new report provides clear, actionable insights throughout the performance year to: 

  • Identify performance trends across panels and providers  

  • Monitor documentation and risk-capture efforts in more real time 

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Target Release Date: 12/4/2025

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Voluntary Alignment Analytic Updates

We are happy to announce that we have included the Voluntary Alignment Status to two existing quick reports..

  1. The Patient Summary quick report includes a new column, indicating if the patient is voluntarily aligned (yes or no).

  2. The Beneficiary Demographics quick report includes several new columns indicating if the patient is voluntary aligned and who their selected TIN and NPI are within the ACO network.

Release Date: 10/14/2025

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ACO REACH Timely Follow-Up After Acute Exacerbation of Chronic Conditions claims-based measure quick report update

  1. CMS ACO REACH recently made updates to the specification value sets in the Timely Follow-Up After Acute Exacerbation of Chronic Conditions claims based measure for the 2025 performance year. 

  2. These value set changes are minor but may slightly adjust measure results for the 2025 performance year. Changes in report results for the 2025 performance year are expected but not guaranteed. 
     

  3. Resource: Measure Information Form (MIF)  and Value Sets are posted in the 4i Knowledge Library

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Scheduled Release Date: 9/23/2025

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ACO REACH PCC (Primary Care Capitation) quick report update

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1. The report filters have been updated to now run the report based on a date range.

2. The report uses the date range and will return all rows where the claim thru date is between the selected dates selected in the filter.

Scheduled Release Date: 9/23/2025

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Pathology and Laboratory Expenditures Report Update

  1. We are excited to announce the Pathology and Laboratory Expenditures report has been updated! The latest version now includes expanded details on facility providers and claim type sources, giving users a more complete view of expenditures. 

  2. This report provides insights into pathology and laboratory spending, including servicing providers and facility types for both Part A and Part B claims. 

Release Date: 9/16/2025

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2025 Risk Adjustment 

The 2025 HCC Risk Scores will be available in the Health Endeavors platform next week. These scores, calculated using the CMS-HCC risk adjustment model, help assess patient risk and optimize resource allocation.

 

To support your team, we have attached an educational resource outlining key updates, recapture rate insights, and platform tools available for accessing HCC data.

 

Release Date: 04/08/2025

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Recorded Webinars

2025 CMS Final Rule Webinar – Join the nationally recognized health policy expert and director of Managing Director of Medicare Services at HMA, Amy Bassano, for a in depth discussion about the 2025 CMS Final Rule. Watch Recorded Webinar

Thursday, December 5th at 2:00 EST

2024 All About Quality Webinar – Join our quality team as we break down all of the options and the step-by-step process of making your reporting season smooth and easy. Watch Recorded Webinar

Thursday, December 12th at 2:00 EST

Planning for 2025 Quality Webinar –Join our quality team as we break down your options and requirements for 2025.  Watch Recorded Webinar

Populations and Programs
  • ACO REACH 

  • Primary Care First (PCF) 

  • Medicare ACO 

  • Medicare Blue Button FHIR

  • Medicare DPC FHIR

  • Medicaid

  • Commercial

  • Medicare Advantage (MA)

  • Self-Insured Employer TPA

  • Remote Patient Monitoring (RPM)

  • Chronic Care Management (CCM)

Health Endeavors

P.O. Box 27290

Scottsdale AZ  85255

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888.862.0366

2024 Health Endeavors

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