Medicare Advantage (MA) plans continue to face mounting pressure to achieve high Star Ratings, comply with evolving CMS regulations, and deliver equitable, high-quality care. The 2025 Star Ratings averaged just 3.74 (weighted by enrollment), leaving many plans short of their quality and revenue goals. With ~$16 billion in quality bonuses on the line, performance in… Continue reading The New Road to Five Stars: Integrated Care Management for 2026 Star Ratings and Beyond
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
The Medicare Advantage (MA) landscape is evolving rapidly, carrying significant implications for providers, payers, and beneficiaries alike. In a recent webinar titled The Future of Medicare Advantage in the Trump Transition – Will AI Help Pave the Way?, InfoMC Board Member and renowned population health expert Dr. David Nash joined fellow industry leaders from the… Continue reading The Future of Medicare Advantage: Finding the True North with AI and Innovation
