Author: Kevin Thilborger
More than halfway through 2025, how good were our predictions?
At the start of 2025 we published our predictions for six key areas to watch in managed care. More than halfway through the year, we check in to see how...
Learn from North Carolina’s model before other states follow suit
North Carolina is rolling out a "no cost" surgical benefit this fall. Here's what providers in and out of North Carolina need to know.
What the heck is going on with MLR and the health insurance business?
Unless patients suddenly stop incurring health insurance claims, there's only one place left for payors to go to get control of rising medical loss ratios: providers. By understanding this, providers...
Q2 2025 earnings for the top payors: the managed care mirage gets murkier
Kevin Thilborger highlights key takeaways from the Q2 earnings calls of top insurance companies.
It may be big — there’s nothing beautiful about it
As millions of people find themselves newly uninsured when the One Big Beautiful Act goes into effect, the burden for absorbing healthcare costs is squarely on the shoulders of providers....
DOJ: Pushing back on alleged kickbacks
The US Department of Justice alleges that three MA plans and their appointed brokers committed offenses against the False Claims Act.
CMS gives increases to Medicare Advantage plans and decreases to physicians
MA plans are bad for taxpayers, beneficiaries, and providers. So why has CMS authorized increased payment rates to MA payors for 2026?
What to expect in 2025: Managed care trends and predictions
New president. New Congress. Decades old healthcare cost finger pointing. Payors and providers say change is needed. Yet there’s no consensus on how to achieve it. In our new report, we share...
More Medicare Advantage turmoil
Medicare Advantage plans face growing scrutiny and rejection by providers due to payment challenges and administrative complexities, prompting hospitals to reassess contracts and seek strategic support for managed care negotiations...