Managed Care Markets
Expert articles and analysis related to managed care markets.
AI Summary — Last 30 Days
Managed care risk is tightening across Medicare and Medicaid: Humana’s planned 2026 Medicare Advantage market exits affecting roughly 600,000 members signal continued MA margin discipline, while CMS’s appeal of Clover’s star-ratings win underscores ongoing volatility in quality-bonus revenue and plan performance strategy. At the same time, the Trump administration is expanding federal oversight and utilization-management experimentation through the WISeR Medicare AI prior authorization pilot—after the Senate rejected an effort to halt it—creating a direct tension between cost control, access, and VBC care-management workflows (Healthcare Dive).
On the Medicaid side, CMS’s provider-tax proposed rule could reduce state financing capacity by an estimated $220 billion over 10 years, while HHS has paused more than $1 billion in Medicaid payments to California and Minnesota over fraud concerns—moves that could pressure supplemental payments, Medicaid managed care rates, and safety-net participation in VBC arrangements (HFMA). CMMI’s LEAD ACO model and Indiana’s planned GLP-1 coverage under the BALANCE model point in the opposite direction—continued use of targeted payment models to push longitudinal accountability and population health management—but the broader market signal is that
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