Insurance and Payors
Expert articles and analysis related to insurance and payors.
AI Summary â Last 30 Days
In the past 30 days, the Trump administration has initiated significant policy considerations impacting Medicare Advantage payment structures, proposing to keep MA rates flat while altering risk adjustment methodsâmoves that have elicited substantial feedback from insurers as they navigate the implications for value-based care (VBC) initiatives. Additionally, the Center for Medicare and Medicaid Innovation (CMMI) is actively engaging stakeholders at the V-BID Summit 2026, emphasizing the integration of value-based models with equity initiatives, which are crucial for addressing disparities in care delivery. As Medicare navigates evolving payment models like the ACCESS model, questions around the adequacy of compensation for health tech innovations are being examined.
Related Articles
Addressing Unmet Health Care Needs Through Insurance Benefit Design: Challenges and Opportunities
Addressing Unmet Health Care Needs Through Insurance Benefit Design: Challenges and Opportunities  Milbank Memorial Fund
Primary Care Is in Trouble. So Doctors Band Together To Boost Their Market Power.
Thousands of primary care practices are fighting to remain financially viable and independent. Many are banding together to form Independent Physician Associations, or IPAs, to increase their market p...
Americans Give Employer-Provided Health Coverage High Marks on Satisfaction, Value and Financial Security
Americans Give Employer-Provided Health Coverage High Marks on Satisfaction, Value and Financial Security  AHIP
Mount Sinai, Anthem fail to reach new contract
The New York hospital giant is now out of network with plans offered by the Elevance subsidiary after the two failed to agree on terms.
Summary of Provisions in HHSâs Proposed 2027 Notice of Benefit and Payment Parameters and Other Key Regulations
On February 9, 2026, the Department of Health and Human Services (HHS) released the proposed Notice of Benefit and Payment Parameters (proposed Payment Notice) for 2027. The notice includes important ...
Health Insurer Financial Performance in 2024
This analysis of trends in health insurersâ financial data shows that insurersâ gross margins per enrollee dipped slightly in 2024 across four markets, remaining highest in the Medicare Advantage mark...
Are payers âquietly erodingâ independent ASC volume?
ASC leaders say the pressure facing independent centers isnât limited to reimbursement cuts, and that payer tactics that restrict network access and redirect referrals are gradually shrinking surgical...
Safeguarding the Core: Data, Claims, and Uptime in Payer Organizations
Safeguarding the Core: Data, Claims, and Uptime in Payer Organizations  AHIP
Prime Healthcare, BCBSIL stare down June 1 deadline for new network contract
Prime Healthcare, BCBSIL stare down June 1 deadline for new network contract  Fierce Healthcare
Provider Identity as a Strategic Growth Lever: Reducing Onboarding Friction and Unlocking Network Performance
Provider Identity as a Strategic Growth Lever: Reducing Onboarding Friction and Unlocking Network Performance  Fierce Healthcare