Report: Growth in MA Is Associated With Lower Total Medicare Spending
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 Sues Aetna As Providers’ Frustration with MA Grows
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.
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Survey on the Healthcare Financial Landscape Offers a Roadmap for Stakeholders
Zelis highlights how employers, payers, and consumers are integrating digital tools to manage healthcare costs.
Do Healthcare CEOs Agree on Whether VBC and MA Actually Save Money?
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 Kaiser Settlement Should End the Guesswork in Medicare Advantage Oversight
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.
2026 Star Ratings Shift: 4 Strategies for MA Plans
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.
Why Providers Can’t Ignore CMS Audits
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.
Beyond Analytics: How Sellers Dorsey is Hard-Coding Value into Medicaid Policy [Video]
How to turn analytics into actual policy outcomes.
Medicare Advantage’s Discipline Era — and Why the Final Rate Notice Matters More Than It Appears
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.
Kaiser Permanente to Pay $556M to Settle Medicare Advantage Fraud Allegations
Five Kaiser Permanente affiliates agreed to pay $556 million to settle allegations from the Department of Justice that they improperly inflated Medicare Advantage payments through inaccurate diagnosis coding. The case is one of the largest risk-adjustment settlements to date — and it signals continued federal scrutiny of the program.
Rising Costs & Medicare Advantage Flaws to Drive Healthcare Reform Talks in 2026
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 Medicare Advantage.
What Do Healthcare Leaders Think About CMS’ Proposed Star Ratings Overhaul?
CMS is proposing major changes to Medicare Advantage Star Ratings, drawing mixed reactions from healthcare leaders.
The Power Behind Enterprise EHR Software for Large Healthcare Systems
Enterprise EHR boosts scalability, interoperability, and governance for large healthcare systems.
Lawmakers Introduce Multiple Bills Aimed at Medicare Advantage Reform
Thirteen House Democrats introduced eight bills to rein in Medicare Advantage and bolster traditional Medicare.
What’s Missing from Your Tool Chest? How Health Plans Can Improve Star Ratings in Medicare Advantage
The pathway for health plans to achieve better Star ratings performance in their MA business depends on creating an ecosystem where providers are supported with the right tools and resources, incentives are properly aligned, and the member experience remains central to all initiatives.
Report: Member Satisfaction in MA Insurers Is Dropping Due to Lack of Trust
Overall customer satisfaction in Medicare Advantage plans is 623 points on a 1,000-point scale, a 29-point drop from last year, according to a new report from J.D. Power.
Insurers are Pulling Back on MA. How Does this Affect Patients?
Many insurers seem to be retreating from Medicare Advantage by exiting unprofitable markets and reducing benefits. This could be extremely disruptive to patients, experts warn.
Employing AI in Coding and Risk Adjustment: 4 Key Recommendations
As CMS ramps up its RADV initiatives in the months ahead, plans should ensure their risk adjustment programs meet the highest standards of accuracy and compliance. Prospective and retrospective analytics enhanced by AI can help plans work with providers to optimize documentation at the point of care and identify coding errors during audit preparation.