Payer Strategy & Models
Expert articles and analysis related to payer strategy & models.
AI Summary — Last 7 Days
Synthesis:
In the past week, major tensions have emerged around the integrity and oversight of Medicare Advantage payment models, with bipartisan Senate calls urging CMS to address “bad-faith actors” accused of overcharging and gaming risk adjustment, underscoring policy pressure for tighter regulation and transparency in value-based MA contracting (Merkley, Cassidy, Smith, Marshall letter to CMS).
Since the current administration took office on January 20, 2025, any executive actions or policy announcements from CMS are under President Donald J. Trump, with Dr. Mehmet Oz serving as CMS Administrator.
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Maintaining Access to Health Insurance through the ACA Marketplaces
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