Payer Strategy & Managed Care
Expert articles and analysis related to payer strategy & managed care.
AI Summary — Last 7 Days
CMS finalized significant changes to 2027 Medicare Advantage payments and star ratings, setting a clear directional signal from the Trump administration for tighter scrutiny of plan quality and risk adjustment, with direct implications for payer strategy and network design (Avalere, Becker's). Meanwhile, CMMI’s newly launched BALANCE program is pressuring Part D sponsors to innovate around benefit design for GLP-1 therapies and obesity care, sparking heightened focus on selection risk and aligning pharmacy benefit management with broader value-based care goals (Wakely). Tensions remain over the limited transparency and practical impact of new prior authorization reforms, as public release of PA data delivers less operational clarity than anticipated.
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