Reimbursement, claims automation, value-based contracts, and data sharing, decoded for the teams navigating a tougher payer landscape.
Insurers are proposing a 15% median increase for 2027 on top of a finalized 20% for 2026, and the filings say plainly that the individual-market pool is now structurally sicker.
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State SFY 2026 capitation certifications are arriving under CMS's latest rate development guide, and the gap between actuarial assumptions and post-redetermination member acuity is now a payer margin problem.
Non-renewal notices must reach members by Oct. 1, and roughly one in ten Medicare Advantage enrollees is in a plan that disappears next year. Health systems inherit the churn.
Insurers have cut 11% of prior authorization requirements under the voluntary pledge, but denial rates of 12% to 18% mean the administrative burden may simply be moving downstream to appeals.
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