Managed Care Markets

Provider-payer friction in managed care intensified as reporting on “25 hospital systems” dropping Medicare Advantage underscores escalating disputes over prior authorization, payment delays, denials, and network economics—an immediate access and attribution risk for MA beneficiaries, ACOs, and health systems managing total cost of care (MA contract exits). In Medicaid, AMGA is pressing CMS under the Trump administration to add stronger safeguards to the Medicaid community engagement rule, warning that work-reporting and eligibility processes could trigger avoidable coverage losses that destabilize primary care panels, population health workflows, and Medicaid VBC arrangements (AMGA letter.