On Wednesday, August 5th from 1:00 to 4:30 PM (EST), a national expert panel will meet to discuss how Medicare updates the way it measures healthcare costs, and you’re invited to listen in.
Most people don’t think about how Medicare decides what “good care” looks like, but these decisions affect every doctor, hospital, and patient in Monroe County. When Medicare updates its cost measures, it changes how healthcare organizations are paid, the care they provide, and how they focus their time and resources.
Since 2007 the healthcare model continues to rapidly evolve. Most people don’t see the connection to their access to care and services since it is a complex process with ever-changing workflows and regulations. A HUGE change is coming in the next few years and we want you to understand your voice matters!
Here’s the simple version:
- Healthy People 2030 sets national goals like improving health equity, preventing disease, and reducing avoidable hospital visits.
- The Affordable Care Act created tools like value‑based care, ACOs, and preventive services that help the system reach those goals.
- Now Medicare is updating its payment models so doctors and hospitals are rewarded for keeping people healthy, not just treating them when they’re sick. Monroe County has data points that are higher than the NYS average; here are the facts for Monroe County and Rochester, N.Y.
Monroe County’s health landscape aligns tightly with HP2030 and CMS priorities:
1. High chronic disease burden
- Diabetes, hypertension, heart disease, and asthma rates exceed NYS averages.
- Cost measures will increasingly reward clinicians who reduce avoidable complications.
2. Preventable hospitalizations
Rochester has persistent rates of:
- CHF admissions
- COPD exacerbations
- Diabetes‑related ED visits
Future payment models will financially reward systems that reduce these through better outpatient management.
3. Health equity gaps
Monroe County has significant disparities by ZIP code:
- 14621, 14605, 14611, and 14613 show higher disease burden and lower access. CMS is moving toward equity‑adjusted payment, meaning clinicians serving high‑need populations may receive additional credit.
4. Strong integrated systems
UR Medicine and Rochester Regional Health already participate in:
- ACO models
- Bundled payments
- Value‑based contracts
This region is well positioned for future CMS payment evolution.
5. SDOH and community partnerships
Food insecurity, housing instability, and transportation barriers are major drivers of cost in Monroe County. CMS is exploring ways to incorporate SDOH into cost measures, meaning local partnerships (Foodlink, Person Centered Housing Options, Connected Communities) become increasingly relevant.
This matters for Rochester because our community faces real challenges: chronic disease, preventable hospitalizations, and health gaps between neighborhoods. Better cost measures mean Medicare can recognize the hard work local clinicians are already doing and encourage more investment in prevention, coordination, and equity.
The upcoming PCMP Technical Expert Panel Webinar will explain how new cost measures are being developed and tested. These measures help ensure that healthcare dollars are spent wisely and that patients get the right care at the right time.
If you care about how healthcare is paid for, or how it can improve, this webinar is worth your time.
PCMP TEP Webinar: Wednesday, August 5 – 1:00 PM – 4:30 PM EST – Virtual meeting (open to the public)
Understanding how Medicare measures cost is one of the most important steps toward building a healthier, more equitable Rochester.
