Medicare Advantage Regulatory Environment
Expert articles and analysis related to medicare advantage regulatory environment.
AI Summary â Last 30 Days
Over the past 30 days, significant developments have emerged in the Medicare Advantage regulatory environment that underscore the ongoing shift towards value-based care (VBC). The introduction of the Long-term Enhanced ACO Design (LEAD) model by CMS is poised to directly link quality performance to financial incentives for providers, reflecting an increased emphasis on payoff for quality outcomes. Additionally, the Transforming Episode Accountability Model (TEAM) is launching its first performance year, presenting both challenges and opportunities for rural health systems as they adapt their cross-continuum capabilities and leadership approaches to meet the new accountability standards. This tightening of performance metrics aims to push providers towards higher efficiency and improved patient outcomes in the VBC landscape. For more details, see insights on the LEAD model and TEAM implementation.
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Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
The Value Shift â How Medicare Advantage Benefits Are Evolving for 2026
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Which types of health insurers make the most money?
It turns out the answer is Medicare Advantage plans according to a KFF analysis released today. However the reason why Medicare Advantage is more profitable may not be obvious: At the end of 2024, gro...
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Letâs start with what seems to be a never-ending topic of conversation: the new policies by Medicare Advantage (MA) plans to deny or reduce payments for inpatient admissions. Last week Independence Bl...
HIMSSCast: 2026 could be the most challenging year yet for Medicare Advantage payers
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Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network
Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network  Clover Health
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About 280,000 older adults experience the âMedicare Cliffâ each year, becoming eligible for Medicare and losing Medicaid coverage when they turn age 65 years due to discontinuities in financial eligib...