To truly deliver on the promise of proactive, preventive care for seniors with complex, chronic conditions, we should move away from the current one-year open enrollment cycle and toward a five-year contract period.
KFF estimates Medicare will spend $13.4 billion on the Medicare Advantage Quality Bonus Program in 2026 amid continued scrutiny of the program.
In an interview, Kyan Health Co-Founder and Chief Commercial Officer Konstantin Struck discussed how Kyan gives mid-market and enterprise employers access to premium workforce mental healthcare, at a price point that is affordable.
Today’s adjustment offers insight into what the next phase of the program is focusing on and will subsequently reward, and why this moment matters, especially for newer and regional plans.
An OIG report found that the three largest Medicare Advantage insurers denied prior authorization requests for long-term acute care and inpatient rehabilitation at higher rates than other MA plans in 2024.
Rosarium Health's seed round was led by Kalos Ventures, with support from ResilienceVC, Rock Health Capital, Symphonic Capital, American Family Insurance Institute for Corporate and Social Impact, Black Tech Nations Ventures and The Council.
Lawmakers introduced the Medicare Advantage Improvement Act of 2026 to tighten prior authorization rules, boost transparency and curb practices that delay care.
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
Ed Park is sincere and passionate about his calling as the CEO of Devoted Health, which provides Medicare Advantage plans to seniors in 29 states. But it remains to be seen if he can do more or the same with less.
A consultant who has analyzed healthcare policy over many decades declares that MA is in the middle of a fundamental reset both in terms of market headwinds and federal scrutiny.
New research from the Elevance Health Public Policy Institute finds that higher enrollment in Medicare Advantage may be linked to lower overall Medicare spending.
Jefferson Health in Philadelphia is suing Aetna over a new Medicare Advantage payment policy that hospitals say unfairly reduces reimbursements for legitimate inpatient stays. The case highlights a broader clash between providers and Medicare Advantage plans over “downcoding” short hospital stays and controlling costs.
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
Healthcare leaders can’t tell whether value-based care and Medicare Advantage are truly lowering costs. Some see promise in these models and ongoing innovations, while others say the programs haven’t delivered measurable savings and point to direct contracting as a more transparent way to control spending.
The settlement demonstrates that enforcement risk is real and substantial, but it also highlights an opportunity. Medicare Advantage oversight does not require years of new rulemaking or experimental pilots because the technical capability to validate documentation at scale already exists and can be deployed today.
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 overall rating.
At the end of the day, it doesn’t matter what your patient mix looks like; your notes can and will be pulled into audits. Waiting until CMS is at your doorstep isn’t a strategy — it’s a risk. Now is the moment to get ahead of it.
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.