Managed Care & Networks
Expert articles and analysis related to managed care & networks.
AI Summary — Last 30 Days
Managed care scrutiny is intensifying around Medicare Advantage network and utilization controls, with HHS OIG finding the largest MA insurers denied prior authorization for long-term acute care and inpatient rehab at elevated rates—fueling provider and specialty-society pressure for MA reforms that better align access decisions with patient-centered VBC goals rather than margin protection (OIG/MA prior authorization findings). At the same time, delivery systems are repositioning for downside-risk readiness through tighter clinically integrated networks—such as seven rural Kansas hospitals forming a CIN to support value-based care—while CMMI’s new model activity under the Trump administration keeps payment innovation central to network strategy and population health infrastructure. The strategic tension for ACOs, health systems, and payers is sharpening: MA and managed care economics still depend heavily on risk selection, prior authorization, benefit design, and network management, even as policy and provider coalitions push for models that reward avoided admissions, post-acute appropriateness, and longitudinal primary care performance ([rural CIN formation](https://news.google.com/rss/articles/CBMixAFBVV95cUxQZi15TUt6V01YQkNCY1dmeFJaSUZZVGMwWnVLVDZaU2ZRWlN1anRGdG1PMEFxa1lfLS1iWkJu
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