Managing services for individuals with intellectual and developmental disabilities (I/DD) has never been more complex or more essential. As states and managed care organizations modernize their I/DD systems, the focus is shifting from administrative oversight to integrated, person-centered care powered by data and technology. But this next chapter isn’t only about efficiency. It’s about dignity,… Continue reading Building a Modern Technology Framework for I/DD Programs and Providers
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
