Payer Strategy & Utilization
Expert articles and analysis related to payer strategy & utilization.
AI Summary — Last 24 Hours
CMS’s 2027 Medicare Advantage rulemaking is sharpening the payer-strategy tradeoff for VBC organizations: payment and Star Ratings changes are arriving alongside consumer-protection shifts that both expand some beneficiary safeguards and unwind others, raising pressure on MA plans and delegated providers to reassess benefit design, utilization management, and risk-adjustment practices. The stakes are heightened by Aetna’s [$117.7M Medicare Advantage false-claims settlement](https://news.google.com/rss/articles/CBMi_AJBVV95cUxNWWxVUXp2cEprZjNNQzk1MXN6WjA2Z3paZGRIUzRKU2lCOUc4WjhPcDdvLWpWQ0VhYjNNYlBqMlVoT1YzdnpTdm9LYlNLMEwydVl5Q3psX3dRSF9GZG9yQnV1WWptY3ZIVDNwZjJyS3VJbUpLUGJrNlAycXZZaUxVeHdBNlRpeGM4Y1FxdXNLaFJudDlUUVAtZklXbjY2cjlLcTEwMFhkYnMyWXJqalY4VThWZm5NektIY1JsMDZlN2ctVUthVFJlRkVSXy13SWdyOTMwTERWR09tWmo4
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