What You Should Know:
- A new report from J.D. Power reveals a significant decline in member satisfaction with Medicare Advantage (MA) plans. The J.D. Power 2025 U.S. Medicare Advantage Study reveals that satisfaction dropped to an average score of 623 out of 1,000, which is down 29 points from the previous year.
- According to the study, the primary cause for this decline is a 39-point drop in members' overall trust in their plans. This trend is occurring in the wake of significant
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Healthcare Policy Regulation & Reform | News, Analysis, Insights - HIT Consultant
Policy: CMS Launches New Oversight Initiative to Verify Medicaid and CHIP Eligibility
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) has launched a new oversight initiative to ensure that enrollees in Medicaid and the Children’s Health Insurance Program (CHIP) are U.S. citizens, U.S. nationals, or have a satisfactory immigration status. The program aims to safeguard taxpayer dollars and protect these vital programs from abuse.
- CMS will provide states with monthly enrollment reports that identify individuals whose citizenship or
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HHS Repeals Policy Linking Hospital Reimbursement to Staff Vaccination Reporting
What You Should Know:
- Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr. today announced the repeal of federal policy that financially rewarded hospitals for reporting staff vaccination rates, a policy he described as coercive and a denial of informed consent.
- “Medical decisions should be made based on one thing: the wellbeing of the person - never on a financial bonus or a government mandate,” said Secretary Kennedy. “Doctors deserve the freedom to use their
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CMS Finalizes TEAM Model: A New Era of Value-Based Surgical Care
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) today issued the 2026 Final Rule that officially codifies the Transforming Episode Accountability Model (TEAM), an innovative new blueprint for tech-enabled, outcome-based care payment models.
- Starting in 2026, TEAM will hold hospitals and health systems accountable for the entire episode of care for major surgeries, from admission through 30 days post-discharge, with the goal of reducing
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Beyond Disruption: 4 Key Strategies for Healthcare Providers to Thrive Under OBBBA
What You Should Know:
- The U.S. healthcare landscape is facing a transformative moment with the signing of H.R. 1, the “One Big Beautiful Bill Act” (OBBBA), into law on July 4. This landmark legislation introduces sweeping changes to Medicaid and Medicare, as well as Affordable Care Act (ACA) subsidies.
- According to Tamyra Porter, Managing Director of Regulatory Advisory Practice at Premier, these shifts present both significant challenges and a rare inflection point for
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PwC Report: US Medical Cost Trend to Remain Elevated at 8.5% in 2026
What You Should Know:
- The U.S. healthcare system is entering 2026 with medical cost trends reminiscent of 15 years ago, facing persistent inflationary forces and significant federal policy changes, according to a new report from PwC.
- The report, "Medical Cost Trend: Behind the Numbers 2026," projects the Group medical cost trend to remain at 8.5% in 2026 (the same level as 2025) and the Individual market trend at 7.5%. Pharmacy costs are a particular concern, projected 2.5
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athenahealth Released Enhanced Capabilities for Value-Based Care
What You Should Know:
- athenahealth, a provider of network-enabled software and services for healthcare practices nationwide releases new and enhanced capabilities designed to further help practices succeed in value-based care (VBC).
- Practices across athenahealth’s network can now use the athenahealth Marketplace to easily find, choose, and integrate with risk-bearing organizations, including Accountable Care Organizations (ACOs), that align with their goals. The initiative aims
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CMS Launches Cell and Gene Therapy (CGT) Access Model for Medicaid Sickle Cell Patients
What You Should Know:
- The Centers for Medicare & Medicaid Services (CMS) launches its Cell and Gene Therapy (CGT) Access Model, a new approach to delivering cutting-edge treatments for people on Medicaid living with sickle cell disease.
- A total of 33 states, plus the District of Columbia and Puerto Rico, will participate in this model, collectively representing approximately 84% of Medicaid beneficiaries with the condition, significantly expanding access to
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New Strategies Needed: No Surprises Act and the Challenges for Payors with Provider Data Inaccuracies
With more than 20 years of experience at a major health insurance company, I’ve seen firsthand how challenging provider data management can be. I’ve worked with teams reconciling files from delegated groups, fielded calls from frustrated providers, and navigated compliance pitfalls that can quickly become operational headaches. But the stakes have never been higher than they are now under the No Surprises Act (NSA).
For years, maintaining an accurate provider directory was considered a best
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Boost Medicare Star Ratings: A Strategic Game Plan for Health Plans
As they navigate complex times, health insurers have their eye on two important financial indicators. And both are moving in the wrong direction. Costs are on the rise while Medicare Star Ratings are on the decline.
Separate but related, the two trends converge on the same idea: health plans need to enable higher quality care at a lower price.
If it sounds like a Herculean feat, that’s because it is. But some health plans are making it happen.
While some of the cost pressures—for
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