7+ hour, 20+ min ago  (209+ words) Further change in the Star Ratings program is inevitable, but one thing won't change: plans that make targeted investments in improving the member experience and clinical outcomes, driven by data, are the most likely to succeed and achieve a higher…...

1+ week, 6+ day ago  (768+ words) The challenge for policymakers is balance: encouraging rigor without unintentionally weakening a program that now serves the majority of Medicare beneficiaries. Thoughtful rate calibration can determine whether this transition strengthens the program or strains it unnecessarily. None of those changes…...

2+ week, 6+ day ago  (425+ words) Included Health is launching an alternative health plan centered on primary care, AI support, price transparency and easier navigation. Included Health, a navigation and virtual care company, is launching into the insurance space with its alternative plan design for employers,…...

1+ mon, 3+ week ago  (535+ words) Rising healthcare costs and flaws in the Medicare Advantage program are likely to dominate healthcare reform discussions in 2026, according to one PitchBook analyst. Potential policy changes could focus on improving affordability in the ACA market and fixing distorted incentives in…...

1+ mon, 3+ week ago  (822+ words) The solution isn't about creating more referral pathways, but about building the measurement infrastructure that enables excellent primary care providers to act confidently on their observations." Medicare's requirement for cognitive assessment in annual wellness visits is well-meaning. However, it has…...

2+ mon, 6+ day ago  (477+ words) Here are three things providers should consider when it comes to Medicare. Medicare open enrollment is in full swing and big changes are on the way in 2026 for providers " from physician fee schedules to a pilot test of prior authorization…...

2+ mon, 6+ day ago  (1481+ words) CMS" new ACCESS model, slated to begin on July 1, aims to shift traditional Medicare fee-for-service toward value-based care by tying payments to patient outcomes and encouraging tech-enabled, preventive care. Experts say it could benefit digitally mature, value-focused providers first, but…...

2+ mon, 2+ week ago  (783+ words) Healthcare costs in America are rising at unsustainable levels. The past two years brought the highest back-to-back cost hikes in a decade " and the trend shows no signs of slowing down as employers brace for another 9% increase in healthcare costs…...

2+ mon, 2+ week ago  (431+ words) CMS is proposing major changes to Medicare Advantage Star Ratings, drawing mixed reactions from healthcare leaders. In recent years, there have been numerous lawsuits from Medicare Advantage plans against the Centers for Medicare and Medicaid Services over Star Ratings, including…...

3+ mon, 6+ day ago  (667+ words) For years, utilization management (UM) was quietly delegated away for scale, speed, and supposed efficiency. But today, health plans are hitting the breaking point. What's emerging isn't just a call for reform; it's a clear shift in strategy: reclaim control,…...