Network Management
Expert articles and analysis related to network management.
AI Summary — Last 30 Days
Network management is tightening across Medicare, Medicaid, and commercial markets as CMS pushes mandatory participation in an expanded joint replacement model by 2028 while the 2027 OPPS/ASC proposal offers only a 2.4% base update—pressuring hospitals, ASCs, post-acute providers, and ACOs to rationalize referral networks around lower-cost sites and episode performance. At the same time, payer retrenchment is accelerating: Humana’s planned Medicare Advantage market exits affecting roughly 600,000 members and broader ACA Marketplace exits signal that plans are pruning geographies and networks where risk adjustment, utilization, and rates no longer support margins, creating disruption but also openings for provider-led VBC platforms and aligned primary care models. Medicaid is also moving toward more explicit population-health tradeoffs, with Indiana seeking GLP-1 coverage for select members under the BALANCE model amid federal spending-cut debates, raising the stakes for states, MCOs, and risk-bearing providers to prove ROI on high-cost interventions through tighter clinical targeting and network accountability (expanded joint replacement model; [Humana MA exits](https://news.google.com/rss/articles/CBMisAFBVV95cUxPdGh3N1NMcUNBaEVjOXdIU1Y4eGtlQjlNaHRwQ
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