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AI in Medicare Advantage: How Health Care Executives Protect MLR and Network Integrity
What happens to your medical loss ratio when every Medicare Advantage recipient has an AI-powered assistant in their pocket? The era of information asymmetry is ending. As Becker's Payer Issues…
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Navigating the Managed Medicaid Margin Crisis
For years, managed Medicaid was a reliable engine of growth and profitability for the nation’s largest health care insurers. However, a significant shift in the landscape has transformed the segment…
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Managing Margin Pressure: CMS Proposes Nearly Flat 2027 Medicare Advantage Rates
The Centers for Medicare and Medicaid Services (CMS) has released the 2027 Advance Notice for Medicare Advantage and Part D, proposing a base rate increase of 0.16%. While CMS projects…
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How Health Care Plans Move Provider Networks from Compliance to Strategic Profitability
The provider network represents the single greatest component of total medical expense for managed care organizations. However, for many executives, network management remains a reactive, fragmented process focused primarily on…
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