Pearl Health

"Always stay focused on the patient. It'll lead you to the right decision almost every single time." That's how our Chief Technology Officer Matt Solnit closes this podcast conversation with Synaxia Group on building an engineering culture in value-based care. He talks candidly about what surprised him moving from web performance into healthcare, how Pearl's team is using AI day to day, and what he looks for when hiring engineers who can keep up with how fast the tooling is changing. The interview offers a real look at what it takes to build technology for primary care providers, not just talk about it. Watch the full interview: https://lnkd.in/gCxGnXTR

In complex systems, prioritization can be just as important as insight. Healthcare organizations have plenty of data on utilization, quality, financial performance, and patient needs. The harder question is often: where should we focus first? That's the problem behind Pearl Health's new Performance Focus Areas, now available directly in the Pearl platform. Pearl Health's Chief Product Officer Jennifer Rabiner and Chief Business Officer Steven Duque explain how Focus Areas bring priority opportunities, potential impact, relevant patients, and recommended next steps and resources together in one place. The goal: make it easier to move from understanding performance to deciding what to do next. Read more → https://lnkd.in/g-y_nqv4 #ValueBasedCare #HealthcareLeadership #HealthcareOperations #HealthTech

Pearl Health's Chief Operating Officer, Gabe Drapos, will be speaking at the virtual America's Physician Groups MSSP Coalition Meeting tomorrow. APG members can tune in noon ET on September 23. APG members, see meeting details and registration: https://lnkd.in/g9rRgCf7

Why are some hospitals walking away from Medicare Advantage contracts? Our CEO Michael Kopko recently spoke with MedCity News about concerns providers have raised: "What we hear from clients is that $1 is now 85 cents." Denial rates have climbed from 7-8% five years ago to around 12% today, and Medicare Advantage plans can't bring that back down without giving up on profitability. The bigger question this raises: is Medicare Advantage the more efficient model, or does traditional Medicare's lower overhead win  as beneficiary numbers keep growing? What’s your take? Read the full MedCity article: https://lnkd.in/g4mq98du #Medicare #MedicareAdvantage #ValueBasedCare

The future of healthcare is being built by people willing to rethink how care is delivered. At Pearl, we believe progress depends on supporting the innovators turning ambitious ideas into real-world impact. That’s why we’re excited to share the 2026 Global Health Venture Forum, bringing together healthcare founders, operators, clinicians, and investors working to move the industry forward. If you’re building a company tackling a meaningful challenge in healthcare, applications are open through September 16. Learn more and apply: https://lnkd.in/eDpmqTNz

CMS proposed something worth the attention of every ACO-curious practice. In the newly proposed 2027 Physician Fee Schedule rule, Centers for Medicare & Medicaid Services is proposing to convert G2211 from an add-on code into a percentage-based modifier and create a second, enhanced modifier for qualifying E/M visits. → The first is available to any qualifying clinician when the applicable billing criteria are met → The second would increase payment for the associated E/M service by twice as much as the general modifier. The second modifier would be available only to qualifying practitioners participating in a Medicare Shared Savings Program ACO or qualifying Participant Providers in a LEAD Model ACO. If finalized, the proposal would create a direct ACO-specific payment adjustment for qualifying E/M visits, recognizing the additional resources associated with longitudinal, accountable care. It's still a proposed rule, not final. The proposal remains subject to public comment and could change before CMS issues the final rule. But it's a clear signal of CMS’s view of the importance of value-based care, reflecting continued effort to connect physician payment more directly to longitudinal care and ACO participation Happy to talk through what this could mean for your practice. Reach out via the email attached. #ValueBasedCare #ACO #MSSP #CMSProposedRule

The journey of Sepsis in Medicare The sepsis cases are expensive. The payments have never decreased over the last decades. The volume has gone up, till the pandemic, and now back again. Price x Quantity - both going up rapidly Source: mimilabs

Sepsis is a powerful illustration of the opportunity in value-based care: both the volume and cost per episode have risen substantially across Medicare. The opportunity is to move upstream: identify rising risk earlier, coordinate interventions, and turn longitudinal data into action before patients reach the hospital. This is exactly the kind of challenge technology-enabled primary care should be built to address. Great analysis from Yubin Park, PhD and mimilabs. #ValueBasedCare #Medicare #PrimaryCare #PopulationHealth #HealthcareInnovation #Sepsis

How can technology drive value-based care forward and deliver better outcomes without creating operational friction? Our CEO, Michael Kopko, sat down with the hosts of Health Care Network to share how Pearl Health is helping Medicare providers align financial incentives, prevent costly hospitalizations, and navigate value-based care. Watch the full interview starting at the 9:52 timestamp. https://lnkd.in/dJ7bpPCf

The conversation around Medicare Advantage (MA) is becoming more urgent. As pressure grows to improve outcomes and manage costs, the question is increasingly: how do we turn financial accountability into better care? High-performing ACOs may offer part of the answer. In our latest blog, Pearl Health CEO Michael Kopko explores what MA can learn from the ACO operating model, and the opportunity to pair insurer-grade financial discipline, with ACO-grade clinical execution. Read more here→ https://lnkd.in/gxFpGu7C #ValueBasedCare #MedicareAdvantage #AccountableCare