Payer Network Management

Medicare Advantage network strategy is tightening as payers prune underperforming products and geographies ahead of the next plan year, with Humana exits affecting roughly 600,000 members and broader reporting that millions may lose MA plan options—shifting risk to brokers, providers, and ACO-aligned groups that must manage continuity, attribution churn, and patient steerage during open enrollment. At the same time, UnitedHealthcare is signaling confidence that it can remain “very competitive” in MA while preserving profitability, underscoring a market split between scale players optimizing networks and benefits versus plans retreating from unfavorable county-level economics (UHC MA positioning). CMS and oversight pressure are also rising around prior authorization transparency and MA supplier/network integrity, including OIG concerns about durable medical equipment suppliers, reinforcing that payer network management is becoming a core VBC execution risk—not just a contracting function—because access, authorization friction, and out-of-network leakage directly affect quality, total cost of care, and member retention (OIG on MA equipment suppliers).