Managed Care Markets

Medicare Advantage is entering a tighter margin-and-compliance cycle: 2027 Star Ratings shifted bonus economics unevenly across carriers, with high-rated MA-PD enrollment still above 70% but underlying measure volatility and cut-point changes creating revenue risk for 2028 rebates and supplemental benefits. At the same time, RADV/diagnosis-coding scrutiny is intensifying as HHS OIG audits and DOJ False Claims Act settlements—such as Independence Blue Cross’s $22.5M MA risk-adjustment settlement—raise the stakes for documentation, coding governance, and provider-delegated risk arrangements. For ACOs, risk-bearing medical groups, and payer partners, the strategic priority is moving from “stars and coding as actuarial functions” to integrated performance management across quality, encounter data, compliance, and care delivery operations (HFMA on 2027 MA Star Ratings; DOJ Independence Blue Cross settlement).