Medicare Advantage & Managed Care
Expert articles and analysis related to medicare advantage & managed care.
AI Summary â Last 7 Days
CMSâs CY 2027 policy cycle is signaling a tighter managed-care and VBC operating environment: proposed MSSP changes would materially affect ACO benchmark calculations, shared savings projections, and financial strategy, while CMS is also putting ACOs on a 2027â2030 path toward FHIR-based digital quality measurementâraising the premium on actuarial forecasting, data infrastructure, and quality operations (Wakely MSSP analysis). At the same time, Medicare Advantage pressure is intensifying as CMS appeals Cloverâs MA Star Ratings lawsuit and Humana plans additional 2027 MA exits after Star Ratings headwinds hit guidance, underscoring that quality scores, risk adjustment, and benefit economics are becoming more volatile for MA-focused VBC organizations (Healthcare Dive on Humana exits). For health systems and ACOs, the weekâs through-line is that CMS under the Trump administration is advancing accountable care growth while making both fee-for-service ACO economics and MA partnerships more dependent on precise measurement, coding discipline, and downside-risk readiness.
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CMS appeals Clover MA stars lawsuit
Tuesdayâs appeal is the latest development in Cloverâs legal saga to get the CMS to recalculate its Medicare Advantage star ratings.
CY 2027 Physician Fee Schedule Proposed Rule Summary â Part I
HFMA presents part I of three detailed summaries of a prosed rule relating to the Medicare physician fee schedule for CY 2027 and other revisions to Medicare Part B. policies. Part I covers sections I...
ACHP Urges CMS to Apply 2026 Hold Harmless Methodology to 2027 MA Star Ratings - ACHP â Alliance of Community Health Plans
ACHP Urges CMS to Apply 2026 Hold Harmless Methodology to 2027 MA Star Ratings  ACHP â Alliance of Community Health Plans
Home Health Consolidated Billing Update
What Medicare Data Reveals About Oncology Spending Trends, Innovation, and Cost Forecasting
New Wakely analysis of seven years of Medicare claims data (2018â2024) shows oncology spending is shaped by therapeutic innovation, adoption cycles, biosimilars, and benefit channel dynamicsânot price...
Prior Authorization Is Draining Revenue: Why Automation Has Become a Strategic Imperative
Prior Authorization Is Draining Revenue: Why Automation Has Become a Strategic Imperative  MedCity News
CMS releases 2027 physician fee schedule proposed rule: Key takeaways for sleep medicine
CMS challenges court-ordered boost to Clover's star ratings
CMS challenges court-ordered boost to Clover's star ratings  Healthcare Finance News
Aetnaâs CMO on the plan to win back providersâ trust
Prior authorization is a major source of concern.
Humana is cutting Medicare Advantage plans to 85% of U.S. counties for 2027 - NewsBreak: Local News & Alerts
Humana is cutting Medicare Advantage plans to 85% of U.S. counties for 2027Â Â NewsBreak: Local News & Alerts