While policymakers have sought to reduce Medicaid program costs for years, significant reforms are gaining momentum under the new Trump Administration. For many health plans, especially many local and regional plans, Medicaid managed care is a primary source of revenue…

Medicaid managed care has remained a highly competitive space in the last 2–3 years, with at least 18 procurements released across 15 states in 2023 and 2024 alone. Procurements are a critical tool for state agencies as they seek to…

This year, many health plans are taking an especially critical lens to the consumer experience and how well consumers believe their coverage and services are addressing their healthcare needs. Health plans enter 2025 against the backdrop of vocal consumer scrutiny,…

The Centers for Medicare & Medicaid Services’ (CMS’) recently released final rule finalized changes to the Medicare Advantage (MA) prescription drug program (MA-PD) for Contract Year 2025 (CY 2025). CMS’ stated goal for the final rule is to strengthen consumer…

Health plans are confronting significant pressure to their financial sustainability, including rising costs, new regulations, and increased competition. Rising medical costs remains an ongoing challenge, with medical expenses outpacing projections in 2023 driven by factors such as post-COVID demand, network…

The demand for services to address behavioral health conditions – inclusive of Mental Health and Substance Use Disorders – has never been greater given changes in cultural acceptance, evolving regulation, increasing attention to integrated care, and most recently, the acute…