Insurance & Payers
Expert articles and analysis related to insurance & payers.
AI Summary â Last 30 Days
In the last 30 days, the Trump administrationâs push to maintain flat Medicare Advantage (MA) payment rates has generated significant feedback from insurers, raising concerns about the risk adjustment calculation changes. Meanwhile, the Medicare ACCESS model faces scrutiny over whether its payment rates are adequate to support the evolving needs of health tech integrations in Medicare, as stakeholders assess the implications for value-based care. These developments reflect a broader trend of payer strategies grappling with regulatory adjustments aimed at improving outcomes while managing costs within the evolving landscape of Medicare and commercial insurance frameworks.
Related Articles
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...
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
Aligning Payer Strategy with Operations
Aligning Payer Strategy with Operations  AMGA.org
GAO Analysis Signals Greater Network Stability After No Surprises Act
GAO Analysis Signals Greater Network Stability After No Surprises Act  HealthLeaders Media
Eos Ventures sees opportunity in the insurance sectorâs complexity
Galen Shaffer, principal at Eos Ventures, says regulation and fragmentation make the insurance industry fertile ground for innovation and investment.