Payer & Managed Care Strategies
Expert articles and analysis related to payer & managed care strategies.
AI Summary — Last 30 Days
Over the past 30 days, structural shifts in value-based care (VBC) have focused on both payment model refinement and operational streamlining, as CMS—under the Trump administration—finalized a 2027 Medicare Advantage (MA) rate notice that increases payments by 2.48%, signaling a supportive stance for MA organizations and providers carrying MA risk (Wakely Rate Notice). Rapid MA Special Needs Plan (SNP) enrollment growth, now surpassing 8.2 million, is fundamentally altering contracting assumptions, particularly for providers in risk arrangements, emphasizing the need for updated population health strategies (Wakely SNP analysis). Meanwhile, CMS’s proposed rule for 2026 interoperability standards includes tighter prior authorization mandates for drug coverage, aiming to reduce friction and administrative burden—an operational shift with direct implications for payer-provider collaboration and VBC delivery.
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Group cutting prior authorizations by 11% includes Aetna, Cigna
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How to win peer-to-peer calls: a medical director’s guide
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Insurers committed to cutting prior authorizations have eliminated 11% so far
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Health Plans Reduce Prior Authorization, Support Continuity of Care and Enhanced Consumer Communications
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Reducing Scope of Claims Subject to Prior Authorization
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AHIP and BCBSA Letter on Improving Communications Related to Prior Authorization Notifications
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