Payer & Insurance Markets
Expert articles and analysis related to payer & insurance markets.
AI Summary â Last 7 Days
Synthesis:
This week saw a major inflection in Medicare Advantage as CMS, under the Trump administration, released the final 2027 Rate Notice with an unexpectedly steep 2.48% average payment increaseâtranslating to roughly $13 billion in additional outlays for MA plans, intensifying debate over whether Trump-era policy is propping up or constraining private insurers (Wakely summary; STAT analysis). As payers tout incremental progress on prior authorization reductions (just 11% cut to date) in response to long-standing VBC complaints, structural inefficiencies in value-based contracts and digital-first approaches remain under scrutiny. Meanwhile, Californiaâs policy innovation pipeline features bold models for Medicaid managed care integrationâincluding proposals to unify provider networks and embed In-Home Supportive Servicesâunderscoring persistent experimentation aimed at improving population health outcomes and administrative alignment.
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CMS proposes easing prior authorizations for prescription drugs
CMS proposes easing prior authorizations for prescription drugs  Modern Healthcare
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A 2024 CMS rule now requires payers, including Medicare Advantage plans, Medicaid, CHIP and ACA exchange carriers, to publicly report prior authorization metrics for the first time. The public report...
Insurers have Cut Prior Auth by 11% Following Commitments
Insurers have Cut Prior Auth by 11% Following Commitments  MedCity News
Insurers Cut 11% of Prior Authorizations, Expand Continuity-of-Care Protections
Insurers have cut prior auth requirements by 11%: AHIP-BCBS
Insurers have cut prior auth requirements by 11%: AHIP-BCBSÂ Â Becker's Hospital Review
Group cutting prior authorizations by 11% includes Aetna, Cigna
Group cutting prior authorizations by 11% includes Aetna, Cigna  Modern Healthcare
Insurers have eliminated 11% of prior auths under reform pledge
Insurers have eliminated 11% of prior auths under reform pledge  Fierce Healthcare
How to win peer-to-peer calls: a medical directorâs guide
I review your peer-to-peer calls. Here is why you keep losing. I sit on the other side of your peer-to-peer call. I am a physician medical director in utilization management. When you call to overturn...
Insurers committed to cutting prior authorizations have eliminated 11% so far
Last summer, major payers committed to pare back onerous prior authorization policies, to the skepticism of providers. Now, AHIP and the Blue Cross Blue Shield Association are providing an update on i...