cme tests / vocabulary / history / definition / current status / effect on providers / types of entities / types of payment / perspectives / considerations / resources / current events

Class Description:

OVERVIEW OF SYSTEMS-BASED PRACTICE

This class introduces key terms and concepts central to systems-based practice in today’s rapidly evolving healthcare environment. A “Framework for Analysis” approach is used throughout this course to examine the healthcare delivery system from multiple perspectives — helping physicians understand how systemic forces directly affect their patients and their practice.

Topics:

OVERVIEW OF SYSTEMS-BASED PRACTICE — 2026 UPDATE

The Framework for Analysis examines the healthcare delivery system through six perspectives: (1) Patients and Families, whose needs and social determinants of health drive population management strategies; (2) Providers, an all-inclusive term encompassing physicians, advanced practice providers (APPs), hospitals, and other care team members; (3) Payors, including governmental programs such as Medicare and Medicaid; (4) Health Plans, such as Accountable Care Organizations (ACOs), Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Managed Care Organizations (MCOs); (5) Employers and Purchasers of healthcare benefits; and (6) Laws, Regulations, and Public Policies encompassing all of the above perspectives.

Review: Analyze the current status of systems-based practice in the United States as of 2026. Value-based care models now account for approximately 60% of U.S. healthcare payments, with CMS aiming to enroll all Medicare and most Medicaid beneficiaries in value-based programs by 2030. As of January 2026, 511 ACOs participate in the Medicare Shared Savings Program (MSSP), serving over 12.6 million people with Traditional Medicare — up from 476 ACOs in 2025. A new 10-year model, the ACO LEAD (Long-term Enhanced ACO Design) model, launches January 1, 2027, replacing ACO REACH and offering improved benchmarks, prospective payments, and a stronger role for specialists. Consider: How do these shifts in value-based payment affect your daily practice and your patients’ care?

Synthesize: Population Health Management, including social determinants of health (SDOH); Interprofessional and advanced practice provider (APP) teams; Communication and care coordination across settings; Quality Improvement (QI); Health Information Technology (HIT), including AI-enabled Electronic Health Records — by July 2026, EHR vendors must provide real-time patient data access and disclose where AI is embedded and how it functions; Health Equity and addressing disparities; Risk stratification; Value-based care; Capitation; and Fee-for-Service.

Describe how systems-based practice is reshaping care delivery — from the continued growth of ambulatory and preventive care models, to the expanding role of augmented intelligence and AI in clinical decision-making, to the policy shift toward cost containment and operational efficiency that defines the current environment. Understand how Laws and Public Policies shape the system in which you practice.

Know what these key terms mean and how they impact your practice:

  • Population Health Management
  • Social Determinants of Health (SDOH)
  • Interprofessional Teams / Advanced Practice Providers (APPs)
  • Health Equity
  • Communication and Care Coordination
  • Quality Improvement (QI)
  • Health Information Technology (HIT)
  • Augmented Intelligence / AI in Medicine
  • Electronic Health Record (EHR) — 2026 Standards
  • Risk Stratification
  • Value-Based Care (VBC)
  • Accountable Care Organizations (ACOs)
  • Medicare Shared Savings Program (MSSP)
  • ACO REACH Model (ending December 2026)
  • ACO LEAD Model (launching January 2027)
  • Capitation
  • Fee-For-Service