Inside Medicare's Invisible Backbone: Claims Processing, AI Innovation, and the $500 Billion System Written in COBOL

Inside Medicare's Invisible Backbone: Claims Processing, AI Innovation, and the $500 Billion System Written in COBOL

Brian Janssen reflects on running Medicare operations at WPS Health Solutions, processing 130+ million claims annually through an infrastructure that many healthcare professionals don't know exists. He shares why MACs are "the largest backbone of processing in the country that the healthcare world doesn't really know about," how regional variation matters when Flint, Michigan's environmental crisis affects local coverage decisions differently than in rural Kansas, and the challenge of innovating with AI while maintaining FISMA High security in physical data centers in systems that can't afford a single day of payment disruption.

Seven Models in One Quarter: Making Sense of CMS's Most Aggressive Innovation Push Ever

Liza Health’s Duncan Reece reflects on decades in value-based care, from Medicare Health Support's failure to today's explosion of CMMI models launching simultaneously. He shares why MSSP's $10 billion in savings gets unfairly criticized against Medicare's $1.2 trillion spend, how Iora built its own EHR from scratch when nothing else worked for accountable care, and why the real unlock isn't payment models: it's separating necessary accountability from unnecessary complexity while technology costs plummet and AI adoption in healthcare outpaces every other industry.

Finishing Interoperability: Inside CMS's Voluntary Framework and the Fight Against Portalitis

Kristen Valdes from b.well reflects on building CMS's voluntary Health Technology Ecosystem framework after discovering that, despite a decade of interoperability policy, live demos showed only 1 out of 30+ providers could return data automatically. She shares lessons on community organizing when 500+ companies need coordination, but the government can't lead, why the real barriers are business and liability issues rather than technology, and how to prevent legacy players from relitigating settled policy when the goal is implementation, not debate.

Where Are We Now? The State of Interoperability in Late 2025

Most healthcare decisions happen far from the headlines. The Policy Stack, hosted by Lisa Bari, reveals the people and processes shaping how American healthcare really works. From state leaders to industry innovators, each episode examines the laws, funding, and political realities behind the policies that shape care.

How Current Healthcare Policy Could Reshape the Future of Value-based Care

In this live episode from Innovaccer’s Mini-Xccelerate conference in DC, Blair Childs and Dave Johnson examine the sweeping policy and market shifts transforming U.S. healthcare. They discuss the move from government-designed systems toward market accountability, how “liberating data” is key to real value-based care, and why structural incentives, not funding, determine the pace of reform. With their deep experience in health policy and strategy, they offer a grounded look at where healthcare is heading, and what it will take to finally realign incentives for better outcomes.