Medicare Advantage (MA) enrollment now tops 34 million beneficiaries, and that number is still growing. But while MA expansion signals success, it also amplifies the complexity and cost of delivering care. Health plans today face a convergence of pressures: Star Ratings are slipping: The average rating fell to 3.92 for 2025, with fewer 4+ Star… Continue reading Built to Scale: How Medicare Advantage Plans Can Grow Without Breaking Their Operations
With growing fiscal pressures and new legislative proposals on the table, Medicaid Plans are facing unprecedented demands to operate more efficiently—without compromising member outcomes or burning out their teams. Recent proposals from the House and the administration signal a shift toward deeper Medicaid reform, tighter federal spending, and increased state accountability. The question for many… Continue reading Navigating Medicaid Cuts: How Health Plans Can Do More with Less
In January 2024, the Centers for Medicare & Medicaid Services (CMS) finalized sweeping new rules aimed at improving the prior authorization process. These changes, set to take effect starting in 2026, will require most health plans to fundamentally rethink how they manage authorizations, interoperability, and member communication. For health plans—including Medicaid managed care organizations (MCOs),… Continue reading Navigating the CMS Prior Authorization Final Rule: What Health Plans Need to Know
