Utilization Management
Expert articles and analysis related to utilization management.
AI Summary — Last 24 Hours
CMS is appealing Clover Health’s Medicare Advantage Star Ratings court win, keeping pressure on MA quality-measure methodology and revenue predictability for plans and value-based provider partners tied to bonus payments and network economics (Becker’s). In Medicaid, AMGA is urging CMS to assess patient-access impacts before finalizing a payment rule, while Milbank’s analysis frames managed care organizations as Medicaid’s core administrative infrastructure—raising the near-term VBC question of whether state MCO contracts are delivering measurable access, utilization management, and population-health value or merely adding administrative friction.
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