Payer Network Management
Expert articles and analysis related to payer network management.
AI Summary — Last 7 Days
Payer network management pressure is intensifying across Medicare Advantage and Medicaid managed care as CMS faces scrutiny over MA plan oversight, including OIG concerns that MA organizations are inadequately screening durable medical equipment suppliers—especially out-of-network entities not enrolled in Medicare—raising fraud, quality, and attribution risk for risk-bearing providers (Healthcare Dive). At the same time, insurer retrenchment in MA and uncertainty around Medicaid managed care rate-setting under the 2025 reconciliation law are increasing the likelihood of plan exits, benefit redesigns, and member churn, complicating population health continuity, network adequacy, and VBC contract performance for ACOs, health systems, and delegated provider groups (KFF).
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