Insights

Helping payer organizations strive for better

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Executive Briefing

Unsustainable? Regional not-for-profit health plans face tough choices over next 2 years

Regional not-for-profit health plans face mounting losses and limited runway. Our analysis shows leaders must act now by pursuing bold turnarounds, mergers, or affiliations to secure their future.

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Executive Briefing

Early look at 2026 Medicare Advantage Stars: Ratings stabilize without meaningful improvement

Star ratings are critical to Medicare Advantage plans, given their financial and strategic contributions. The Centers for Medicare & Medicaid Services (CMS) publicly released the 2026 Star ratings data for all contracts.

Case Study

Reconnecting to strategy: Healthcare organization creates owners’ mindset across workforce

Midwest health org turns sprawling plans into a simple, usable strategy, training 12,000 staff with an owners’ mindset.

Case Study

Creating alignment: Healthcare organization connects change to a vision for the future

Healthcare organization aligns workforce on ERP and program changes with a clear strategy and leader toolkits—reducing change fatigue and building support.

Case Study

A confident direction: Regional payer leverages research in decision-making for potential affiliation

Regional payer uses custom research to guide potential affiliation—elevating local presence, informing messaging, and securing strong partners.

Case Study

Preserving trust: Nonprofit health plan exits MA market with clear, thoughtful communications

Nonprofit health plan exits Medicare Advantage with clear, compassionate communications—minimizing disruption, maintaining trust.

Executive Briefing

Next-level payer-provider collaboration can help mitigate the impact of Medicaid cuts

The impending cuts to Medicaid funding will pull at the fabric of US communities, health systems, and payers. But strategic collaboration could help mend—or even prevent—some of the anticipated tears.

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Executive Briefing

Succeed in value-based care: A P&L strategy drives sustainable results

Health plans that implement VBC programs with clarity and operate with a P&L mindset will drive sustainable profitability—extracting value for members, providers, and their organization.

Executive Briefing

Outpacing Washington: How state Medicaid policies are moving faster—and how MCOs should respond

States are quickly adapting to Medicaid reforms. We highlight notable state-level policy changes and offer strategies for managed care organization (MCO) operational and financial sustainability.

Executive Briefing

No Suprises Act data through Q4 2024 highlights need for payers to rethink their strategy

New CMS data through December 2024 reveals a dramatic uptick in No Surprises Act disputes and in resulting reimbursements. We discuss the trends and share five steps for payers to effectively respond.

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