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Getting 20 million people health coverage for the first time through the Affordable Care Act (ACA) is no small feat. But the law’s politics may have overshadowed a more lasting effect: the power of the Center for Medicare and Medicaid Innovation (CMMI) to remake the healthcare system over time, say two people who were there at its inception.

Former HHS Secretary Kathleen Sebelius, who led the department when the ACA passed, and Sachin H. Jain, M.D., MBA, the CEO of SCAN Health who helped launch CMMI in the Obama administration, discussed the center’s missed opportunities and untapped potential during a session, “What’s Next for the ACA and Health Reform,” during 

 Datapalooza and National Health Policy Conference. The virtual event opened Tuesday and continues through Thursday.

Sebelius reminded the audience that the focus on health IT really started before the ACA passed. A part of the Recovery Act called HITECH—the Health Information Technology for Economic and Clinical Health Act—offered up to $37 billion to spur investment in health information technology and specifically into the nationwide adoption of electronic health records.

That step, Sebelius said, allowed for the data gathering led to value-based payment models and payment for performance, instead of payment for doing tasks. Before he moved to CMMI, Jain played a central role in implementing HITECH.

The law “laid the foundation for the next generation of healthcare,” Sebelius said, “Although people had talked about value-based payments and there was a lot of conversation about changing the way the government looked at health care, Medicare—which was the largest payer—and the federal government was entirely fee-for-service and entirely just paid for stuff you did. You did more stuff you got more payment.”

At that time, she said, Medicare “was disconnected from value or from outcomes that it was impossible for the private sector, for the health systems or providers to really shift into quality performance, and there was basically no payment for keeping people healthy. It was all about doing more procedures.”

Creating data systems was the first step toward paying for value, she said. “And that, I think, was one of the most revolutionary parts of what happened in those early days.”

The Best Kept Secret: the Innovation Center

The controversy and delays to get the ACA passed meant many overlooked a key tenet of the law: the creation of a government research and development center, which would have money and a testing protocol—and most of all, the authority to implement models if it found that they could be shown to have the same quality at a cost savings. This was extraordinary, Sebelius said.

“You can put them in place administratively. So, for the first time, you really had administrative authority that could change the way the system worked,” she said. “The fact that you didn't [have to] run clinical trials and then come back to Congress and get permission, because Congress always protects the status quo. They always have winners and losers they're always playing a zero sum game. All that would happen in Congress is you would just add a new payment system on top of the old payment systems and things would get more expensive. So CMMI finally broke that open."

Plus, it had a $10 billion self-funding pool, which still exists.

Jain asked whether it would have been better, in retrospect to focus the early funding rounds on fewer, more focused projects that could have been quickly brought to scale instead of funding lots of smaller pilot projects. But Sebelius, a former Kansas governor and state insurance commissioner, explained the value in sharing the wealth and creating buy-in for an entity that had just received a huge level of statutory power.

“It did give everybody a little bit of something,” she said. It was a “soft launch,” instead of “a hammer launch.”

“And I still don’t think most people know it even exists,” Sebelius said. “And that’s just fine.”

Jain pointed out that when Sebelius arrived on the job in 2009, the country was also in the midst of a pandemic, H1N1, which at the time was the first one in 70 years.

Back then, the United States devised a national vaccination campaign to deal with the outbreak. “Some of what we’re going through right now seems very familiar,” Sebelius said.

In addition, a major health bill had not been passed since the creation of Medicare and Medicaid in 1965. Sebelius felt the desire in Congress to enact new health legislation had been pent up over the years and was encouraged under the new president.

“He [Obama] was a believer and said over and over again, you can't fix the economy unless you fix healthcare and believed that, and that was really our mission,” Sebelius said.

Looking back, the former secretary said she would not have fought so hard to gain Republican support of the bill by adding amendments only to ultimately have the bill pass without any Republican votes. “If we knew we would not have Republican votes we could have moved a lot faster and had a different version of the Affordable Care Act at the outset, because we would not have tried to incorporate so broadly ideas that we thought might bring votes with them. But unfortunately, we got the ideas and not the votes,” she said.

Referring to how the politics played out, the ACA, “was really, essentially a very pro-private sector healthcare bill that ultimately got painted as something very different,” Jain said.

Touching on the challenging road ahead for President Biden’s HHS secretary nominee, California Attorney General 

, Sebelius endorsed the nominee’s previous defense the ACA in his home state and lauded his previous work with immigrant children, family issues, and underserved populations. “I think he is really well equipped to come into that job with a lot of experience, a lot of expertise, and knows where the administrative levers are to roll back some of the really dangerous precedent that's been put in place by the Trump administration.”

The bigger challenge, says Sebelius, will be whether the Biden administration pauses to build a bipartisan coalition or take advantage of the Senate and House majorities to quickly enact reforms. “I'm hoping they really put the gas down,” said Sebelius, “because there's an opportunity, not only to put the framework of the ACA back together, but there's a lot in this COVID-19 [relief] 

 that would actually enhance the affordability of health insurance. For a lot of people who qualify, it still is not affordable.”

Capping out-of-pocket costs, removing barriers to Medicaid enrollment, and more robust subsidies could all aid in improving uninsured rates that spiked as a result of the pandemic, she added. With newly proposed programs aimed at increasing health equity and public health more broadly, Sebelius hopes Biden-era policies will make it so “people will have less contact, hopefully, with the clinical side of health care and more contact with communities where they can live, and eat, and work, and breathe in, and live in a healthier fashion for longer lives.”

Dr. Sachin Jain and former HHS Secretary Kathleen Sebelius discussed the potential of the Center for Medicare and Medicaid Innovation during Academy Health's Datapalooza and National Health Policy Conference.

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Conference

Sebelius, Jain Reflect on Power of Innovation Center to Change Healthcare

Montefiore Health System is looking to join forces with another New York system.

Montefiore and Garnet Health have signed a letter of intent to explore an affiliation. The two organizations announced the plans last week. 

Regulators need to approve the transaction. Montefiore and Garnet Health are hoping to complete due diligence and sign a definitive agreement by the end of 2025. Garnet Health said the transaction is not an acquisition. 

An academic health system, Montefiore operates 10 hospitals and more than 200 outpatient care sites. 

Garnet is based in Middletown, N.Y., about 60 miles northwest of New York City. Garnet operates three hospitals with a total of 552 beds, along with clinics and outpatient facilities. The system serves ​​500,000 residents in Orange, Sullivan and Ulster Counties.

After a slow start in 2025, hospital merger activity is rising

Jonathan Schiller, president and CEO of Garnet Health, said an affiliation with Montefiore would lead to better healthcare services and “reflects our continued commitment to ensuring the long-term strength and sustainability of healthcare in our region.”

“Joining Montefiore Health System will enable us to bring expanded resources and clinical capabilities to our patients while preserving the community-focused care that has defined Garnet Health for generations,” Schiller said in a statement.

In June, Garnet announced that it was laying off 42 staff, citing the difficult financial climate. At the time of the staff cuts, Garnet said it was committed to a path toward a stable financial future.

Garnet has more than 4,000 employees and 850 medical staff members.

Dr. Phillip O. Ozuah, president and CEO of Montefiore Einstein, said he’s enthusiastic about the partnership with Garnet Health.

“Montefiore Health System knows what it takes to deliver excellent care at a community level while offering access to world-class, academic medical expertise,” Ozuah said in a statement. “We look forward to the opportunity to welcome Garnet Health into the Montefiore family. Together, we share a deep commitment to local healthcare access, clinical excellence, and community care.”

New York has seen a number of hospital deals in the past two years.

The Westchester Medical Center Health Network

 and Bon Secours Mercy Health announced last month that they are ending a decade-long joint venture in the operation of the three hospitals.

Westchester is now assuming full ownership of the three hospitals in New York’s Hudson Valley: Good Samaritan Hospital in Suffern, N.Y.; Bon Secours Community Hospital in Port Jervis, N.Y., and St. Anthony Community Hospital in Warwick, N.Y.

Northwell Health completed the acquisition of Nuvance Health

 in May to form a combined system with 28 hospitals and $22.6 billion in revenue. Nuvance operates seven hospitals in western Connecticut and New York’s Hudson Valley.

Two central New York systems, Arnot Health and Cayuga Health, completed their merger in January

. The combined organization is now known as Centralus Health.

Northwell Health’s new CEO outlines top priorities

Editor's note: This article has been updated to reflect that the transaction is not an acquisition.

The system is looking to add Garnet Health. The organizations are hoping to reach a definitive agreement by the end of the year.


Montefiore plans affiliation with 3 New York hospitals

The HLTH conference has gained a reputation as a showcase for healthcare technology, with a bit of the flair and flavor of Las Vegas.

HLTH returns to Sin City again this year, with the four-day conference beginning Sunday. The conference is going to place 

a heavy spotlight on artificial intelligence

 in health care, and the event will feature hundreds of conversations on digital health, business, consumer products and federal policy.

More than 12,000 people are expected to attend the conference this year, says Rich Scarfo, president of HLTH.

HLTH 2025 Preview: AI, federal policy, and health access

Beyond the numbers, though, HLTH is drawing key leaders across the healthcare industry. More than 2,700 chief executive officers in the healthcare industry will be attending the event at the Venetian Expo Center. About 37% of HLTH’s audience comes from the C-suite, Scarfo says.

“It's great to have an event that is stable, that's growing, and that is very important to us. It's more important to have the right people there,” he says.

(See part of our conversation in this video. The story continues below.)

HLTH President Rich Scarfo gives an overview of the big event in Las Vegas

HLTH 2025: Key themes of the health tech conference

HLTH is also bringing key health players in the federal government. The conference comes as the partial shutdown of the federal government continues, stretching beyond two weeks with no end in sight.

“It's an interesting time right now, and events like ours, because we bring together key leaders from, the payer, provider, investment, employer, health, tech and government sectors,” Scarfo tells Chief Healthcare Executive®. “It's a really perfect platform to discuss both the challenges that we're going through and a lot of the opportunity.”

“We tend to do okay in periods like this. We're actually coming back with a larger event in terms of sponsors and attendees and speakers. So, that is something that we're really happy about,” he said.

HLTH has registered about 1,000 sponsors, which is an increase of about 15% over last year, Scarfo says.

Even with some healthcare organizations trimming their budgets, Scarfo says he’s encouraged by the strong attendance this year.

“We have heard across the board from companies that budgets are cut, and they can't do what they did last year, or they're sending less people, and that's okay. Because you can't just depend on people coming back,” Scarfo says.

But HLTH has developed more partnerships and is bringing in new delegates. HTLH is bringing more startup companies, and the show’s start-up pavilion is sold out.

The conference’s AI space and its digital hub pavilion are also both sold out, Scarfo says.

“All of these areas that are really ones that are heavily dependent on the newest and most innovative technologies, which startups deliver a lot of that, are doing very well this year,” he says.

The event will also feature about 600 speakers, including the main stage and on other stages spaced around the showroom floor.

The bigger names include Mark Cuban, the entrepreneur and owner of Cost Plus Drugs, an online pharmacy selling prescriptions at a discount. Cuban is a familiar face from his years on “Shark Tank” and as the owner of the Dallas Mavericks (he is no longer the principal owner but he still retains a partial stake in the NBA team.)

Rob Lowe, the seemingly ageless actor and longtime advocate for cancer research, will be speaking at the conference.

HLTH has routinely welcomed household names to the conference, with last year’s event featuring 

. But Scarfo said it’s not about simply bringing some star power to the event.

“We really vet them very carefully to make sure that they have an alignment with a key topic that's really important, and will add some value to a discussion with the audience. So, there's a purpose behind it,” he says.

Editor’s note: Chief Healthcare Executive will be reporting from the HLTH Conference in Las Vegas. Look for our coverage throughout the event.

Thousands are attending the health technology conference in Las Vegas, which began Sunday. Hundreds of sessions will feature AI, digital health, and federal policy.



HLTH 2025: Health tech conference continues to grow 

Thousands of employees at hospitals and health systems have lost jobs in recent months.

Several health systems have announced layoffs since the beginning of June. Some point to mounting financial pressures, or the impact of grant terminations from the National Institutes of Health, the prime source of federal research funds.

Others cite uncertainty in federal funding, and health systems have warned that 

 will force hospitals to reduce staff and programs.

Hospitals and health systems have had only modest operating margins in 2025, according to 

 by Strata Decision Technology. Median hospital operating margins were only 1% in August.

Hospitals should expect more volatility in coming months

Providence, Adventist Health, Banner Health, Children’s Hospital Los Angeles, among others, have all announced staff reductions since June.

 that it was reducing the equivalent of 600 full-time positions across the health system, which employs more than 125,000 people in seven states.

Erik Wexler, president and CEO of Providence, told Chief Healthcare Executive® in 

 that the system has reduced its management team and says most staff reductions haven’t been in the clinical space.

But he says the system is also evaluating all of its programs as it looks to be more efficient with looming Medicaid cuts and other cost pressures. Providence will also scale back some services in areas where necessary, and that will likely mean other reductions in the future.

When asked if Providence could reduce more staff in the future, he said, “Unfortunately, I think we will, as we continue to de-cannibalize programs.”

Vanderbilt University Medical Center said in June that 

it plans to lay off more than 600 workers

, citing federal funding cuts by the Trump administration. The academic health system plans to cut operating cuts by $300 million.

The medical center said the cuts are being made “in response to the impact of budgetary actions in Washington, DC related to government-sponsored research and patient care,” 

UC San Diego announced the layoff of more than 200 staff in June, 

. The health system cited “mounting financial pressures caused by federal impacts to health care, regulatory uncertainty and rising costs of providing care combined with reimbursement rates from Medicare, Medicaid and insurers that fail to keep pace with the true cost of care.”

 that the system was laying off 125 employees, just under 1.5% of the workforce. The system said most layoffs were in administrative positions. MetroHealth cited mounting cost pressures, and noted that the system lost $50 million in 2024 and expects greater losses in 2025.

Christine Alexander-Rager, MD, MetroHealth president and CEO, acknowledged that it’s a difficult time.

“We made these decisions in response to significant financial challenges facing our system,” she told staff in July. “Despite your hard work and steady growth in our volumes, MetroHealth’s expenses continue to outpace revenues. And that gap is growing.”

 it planned a restructuring affecting 439 workers, or nearly 6% of its workforce. The hospital terminated 253 employees, and offered 186 the chance to move into different roles.

The pediatric health system noted declining reimbursements from Medi-Cal, California’s Medicaid program, among mounting cost pressures. The system had already taken other steps before layoffs, including a hiring freeze and efforts to manage the costs of supplies.

Paul S. Viviano, CEO of Children’s Hospital Los Angeles, said in August that it was “a very difficult decision, and it is a deeply painful moment for our entire team.”

“It became increasingly clear that reductions to both team member and management roles were necessary to ensure CHLA can continue to survive in this uncertain climate to provide our young patients and their families with the quality care that they need and deserve,” Viviano said in a statement announcing the staff cuts.

Adventist Health, based in California, said in August that it would be laying off nearly 300 employees.

Banner Health in Colorado is planning to lay off 351 employees at Banner McKee Medical Center, 

 by the state’s labor department in early September.

Banner is transitioning the Banner McKee Medical Center in Loveland to a specialty hospital. The transition of the medical center is slated to be done by Nov. 5.

Seattle Children’s announced in September that it was laying off over 150 workers, and that more than 350 open positions won’t be filled. The hospital said that most of the layoffs are in administrative roles, 

 that the system is laying off 300 people across the organization, representing about 3% of the Maine-based system’s workforce. The system said most of the layoffs are in non-clinical roles, but some clinical staff were affected.

Jay Reynolds, MD, senior vice president of Northern Light Health, said last month that the changes are part of a broader effort to strengthen the system. Northern Light also closed Inland Hospital in May.

“Hospitals and healthcare providers across Maine are facing a perfect storm, and these challenges are especially acute in rural areas, where small hospitals and clinics struggle to remain viable and meet the needs of our aging, remote populations,” Reynolds said.

UC Health in Cincinnati said in September that 50 staffers were losing jobs and a mobile stroke unit was being discontinued to reduce costs, 

Kaiser Permanente said in early October that the system was laying off 216 workers, 

Jefferson Health said it is laying off over 600 workers, or about 1% of its workforce. The staff reductions were announced Oct. 16.

Facing mounting costs and uncertainty in federal funding, several health systems across the country have cut the size of their workforce recently.


Hospitals have laid off thousands since June

Gain strategies for streamlining credentialing and onboarding of locums and employed providers.

Credentialing and Onboarding for Locum Tenens

Andrea L. Leland, MBA, CPRP, explains how Dartmouth Health navigates new NCQA credentialing requirements and administrative challenges that extend onboarding timelines for both locum tenens and W-2 physicians. By creating checklists, educating partners, and leveraging temporary and locum tenens licensing, the organization accelerates credentialing while maintaining compliance and quality standards.

Understand new requirements for credentialing and onboarding physicians. Gain strategies to streamline the credentialing process.

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