Health Plans

Health plans are repositioning around tighter utilization management, care coordination, and data infrastructure as cost pressure rises from GLP-1 obesity coverage, AI-enabled provider coding intensity, surgical spend, and post-acute care use; the strategic tension is shifting from blunt prior authorization toward predictive diversion, outcomes optimization, and compliance with the 2027 CMS Prior Authorization Rule. For VBC stakeholders, this means ACOs and risk-bearing providers should expect payers to demand stronger evidence of avoidable utilization reduction, coding integrity, and total-cost accountability, especially as health plans flag provider AI documentation tools as a driver of higher commercial trend and reassess high-cost benefit design such as GLP-1 coverage.