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 can better prepare for what’s ahead.
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 our views on six areas to watch in managed care this year.
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 and partnerships.
UnitedHealth Group – The “Death Star” of U.S. healthcare
UnitedHealth Group’s aggressive acquisition strategy, particularly in areas where it dominates Medicare Advantage, highlights its influence over the U.S. healthcare system and underscores the need for providers to understand and strategically navigate its impact.
So much Medicare Advantage noise, so little time
Medicare Advantage plans have grown significantly, benefiting insurers through higher taxpayer costs driven by coding intensity, while raising concerns about their effectiveness and necessitating strategic evaluation by providers and government accountability.
Three things you need to know about Medicare Advantage today
Medicare Advantage’s rapid growth is straining hospitals and health systems due to low reimbursement rates, rising denials, and payment disputes, requiring providers to adopt data-driven strategies and proactive contract negotiations to maintain financial stability.
2023 revenue challenges: Turning the tide in 2024
In 2023, hospitals and health systems faced financial pressures from Medicaid redeterminations, Medicare Advantage’s rapid growth, and shifting expectations of commercially insured patients, requiring proactive strategies in reimbursement, contract negotiations, and patient retention to navigate these challenges effectively.