Payer & Managed Care Strategies
Expert articles and analysis related to payer & managed care strategies.
AI Summary — Last 7 Days
Over the past week, CMS finalized the 2027 Medicare Advantage Rate Notice, ultimately raising the average payment increase to 2.48%—a significant shift from prior proposals—adding approximately $13 billion in new payments for MA organizations. This move has amplified tensions in the value-based care space, as the payment boost, intended to support care transformation, also risks further entrenching insurers’ market power while failing to address persistent misalignments in value-based care program structure highlighted in recent expert commentary (e.g., program incentives and risk arrangements needing reform). Meanwhile, CMS also released a proposed rule to mandate faster, electronic prior authorization for prescription drugs, signaling an increased regulatory focus on managed care plan accountability and interoperability—critical issues for ACOs and population health initiatives. Week in Washington 4/9/26 | Payers need to speed up prior authorization for drugs under proposed rule
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Payers need to speed up prior authorization for drugs under proposed rule
Health insurers face a prior authorization prescription drug mandate similar to the rule imposed on claims, under a proposal released Friday by the Centers for Medicare & Medicaid Services.CMS is prop...
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Drugs were left out of a 2024 rule streamlining prior authorizations by making decisions electronic and requiring payers to turn them around more quickly. The Trump administration is looking to addres...
How CVS Caremark is using innovative technology to simplify the prior authorization process
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Administrative burden is driving severe physician burnout
You trained for years to become a physician so you could heal people. Yet every day, you find yourself fighting the very system that is supposed to support you. A patient presents with classic symptom...
CMS proposes easing prior authorizations for prescription drugs
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CMS releases proposed rule establishing electronic standards for drug prior authorizations
CMS releases proposed rule establishing electronic standards for drug prior authorizations American Hospital Association
Prior authorization by the numbers: 10 stats that show the strain
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
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Insurers have cut prior auth requirements by 11%: AHIP-BCBS
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