Payer Strategy
Expert articles and analysis related to payer strategy.
AI Summary â Last 30 Days
CMSâs 2027 Medicare Advantage rulemaking is sharpening the payer strategy divide: the Trump administration is pairing payment and Star Ratings updates with a mixed consumer-protection posture that strengthens some beneficiary safeguards while rolling back other prior requirements, creating new uncertainty around plan bids, network design, utilization management, and provider contracting risk in MA VBC arrangements (KFF). At the same time, bipartisan legislation targeting MA access and quality signals continued congressional pressure on prior authorization, network adequacy, and care continuityâissues that directly affect ACO-aligned providers, home health agencies, and specialty groups increasingly dependent on MA revenue. In oncology, evidence that the Oncology Care Model reduced chemotherapy use and Medicare spending in poor-prognosis cancers reinforces a broader strategic shift toward specialty-focused value models where payers can target high-cost episodes with clearer clinical appropriateness metrics (AJMC)
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OKEMOS, Mich., April 15, 2026 /PRNewswire/ â Wakely Consulting Group, an HMA Company, today released a new analysis of the Affordable Care Act (ACA) individual market that points to meaningful changes...
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