Insurance & Managed Care
Expert articles and analysis related to insurance & managed care.
AI Summary — Last 30 Days
Over the past 30 days, the Medicare Advantage (MA) landscape has been defined by intensified scrutiny of payment integrity, with bipartisan lawmakers urging CMS to address MA overpayments and upcoding—underscoring a policy shift towards tighter oversight and potentially lower future payment rates for plans and risk-bearing providers (Healthcare Dive). Simultaneously, rapid MA Special Needs Plan (SNP) enrollment—up 23% in two years—signals accelerating risk concentration among high-needs populations, prompting provider organizations to reassess contract assumptions and capabilities for managing complex risk (Wakely analysis). These dynamics, coupled with new requirements for digital quality measurement and ongoing demand for data scale in behavioral health VBC, reflect mounting structural pressures for both payers and providers to modernize infrastructure and rigorously manage risk as value-based models mature under current CMS leadership.
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The Current Prior Authorization Landscape
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Health plans’ commitments to simplify prior authorization for patients and providers
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