Managed Care Operations
Expert articles and analysis related to managed care operations.
AI Summary — Last 7 Days
Medicare Advantage operational friction is intensifying even as MedPAC’s observational work suggests MA growth has not broadly damaged hospital or post-acute finances, shifting the debate from aggregate margin impact to utilization management burden, network participation, and care-transition execution for providers in value-based contracts (HFMA on MedPAC findings). The sharpest pressure point is post-acute care: higher MA prior authorization denial rates for PAC services, combined with provider-plan contracting moves such as CarolinaEast dropping BCBS Medicare Advantage while delaying its UnitedHealthcare exit, signal that discharge planning, SNF/home health access, and total-cost-of-care performance are becoming increasingly dependent on payer-specific operating rules. In Medicaid managed care, states and plans are continuing to operationalize behavioral health integration through contract requirements around care coordination, quality, and payment, while compliance and access scrutiny—including OIG findings on medications for opioid use disorder—raise the stakes for population health infrastructure and delegated-risk oversight (NASHP Medicaid managed care snapshot).
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