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News
CMS Issues Preliminary Guidance on Medicaid State Directed Payments Ahead of Final Rule
09/15/2025
Grace Taylor, MS, MA
The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance to states on new payment limits for Medicaid State Directed Payments, giving payers and managed care programs an early look at significant changes taking...
The Centers for Medicare & Medicaid Services (CMS) has released preliminary guidance to states on new payment limits for Medicaid State Directed Payments, giving payers and managed care programs an early look at significant changes taking...
The Centers for Medicare &...
09/15/2025
First Report Managed Care
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Commentary
Optimizing Risk Adjustment and Quality Measurement With AI
09/15/2025
Deepan Vashi
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier entries in this series, artificial intelligence (AI) is proving useful in streamlining health plan operations of all sorts. AI tools can also augment human expertise for optimal results in less structured but...
As we’ve covered in the earlier...
09/15/2025
First Report Managed Care
News
Hochul’s Medicaid Spending Surges, With Persistent Focus on Quality by Experts
08/27/2025
Danielle Sposato
Governor Kathy Hochul has added $17 billion in new state Medicaid spending over four years, a 61% increase that outpaces all other state-funded programs combined. Despite this unprecedented investment, according to a newly published article...
Governor Kathy Hochul has added $17 billion in new state Medicaid spending over four years, a 61% increase that outpaces all other state-funded programs combined. Despite this unprecedented investment, according to a newly published article...
Governor Kathy Hochul has added...
08/27/2025
First Report Managed Care
News
Medicare Advantage Plans See Double-Digit Satisfaction Drop as Medical Costs Soar
08/22/2025
Juliet Gallagher
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with Medicare Advantage (MA) plans has seen a significant decline, according to J.D. Power’s 2025 report, reflecting a broader set of financial and policy pressures now facing the MA landscape.
Member satisfaction with...
08/22/2025
First Report Managed Care
Interview
The Future of Medicaid: Standardized Data, Equitable Care, and AI-Powered Access
08/18/2025
Ryan Bullock
A health care executive from Aeroflow Health discusses how the Centers for Medicare & Medicaid Services (CMS)–driven push for interoperability standards, real-time patient data integration, expanded telehealth access, and the use of...
A health care executive from Aeroflow Health discusses how the Centers for Medicare & Medicaid Services (CMS)–driven push for interoperability standards, real-time patient data integration, expanded telehealth access, and the use of...
A health care executive from...
08/18/2025
First Report Managed Care
Quiz
Medicare Advantage Markets Remain Highly Concentrated
08/04/2025
A study found that Medicare Advantage (MA) markets across the US were classified as highly or very highly concentrated in 2024, raising questions about the competitive dynamics of this rapidly growing insurance sector. Learn more.
A study found that Medicare Advantage (MA) markets across the US were classified as highly or very highly concentrated in 2024, raising questions about the competitive dynamics of this rapidly growing insurance sector. Learn more.
A study found that Medicare...
08/04/2025
First Report Managed Care
News
Physician Exodus from Medicare Surges Post-COVID: Alarming Rise Among Primary Care Providers
08/01/2025
Grace Taylor, MS, MA
Physician departures from Medicare have surged post-pandemic, with primary care and solo practitioners leading the exodus, raising urgent questions about coverage stability and network adequacy.
Physician departures from Medicare have surged post-pandemic, with primary care and solo practitioners leading the exodus, raising urgent questions about coverage stability and network adequacy.
Physician departures from...
08/01/2025
First Report Managed Care
News
Health Outcomes Are Superior in Fill-Risk Medicare Advantage vs Traditional Medicare
07/21/2025
Lisa Kuhns, PhD, MD
Medicare Advantage (MA) plans with 2-sided risk arrangements consistently outperform traditional Medicare (TM) on measures of quality and efficiency, according to a study published in The American Journal of Managed Care.
Medicare Advantage (MA) plans with 2-sided risk arrangements consistently outperform traditional Medicare (TM) on measures of quality and efficiency, according to a study published in The American Journal of Managed Care.
Medicare Advantage (MA) plans...
07/21/2025
First Report Managed Care
News
Managed Care Insurers Brace for Q2 Declines Amid Policy Shifts and Rising Costs
07/17/2025
Grace Taylor, MS, MA
Most major US health insurers are expected to report lower Q2 earnings as rising Medicare Advantage costs and looming Medicaid policy changes weigh heavily on financial performance.
Most major US health insurers are expected to report lower Q2 earnings as rising Medicare Advantage costs and looming Medicaid policy changes weigh heavily on financial performance.
Most major US health insurers...
07/17/2025
First Report Managed Care
News
North Carolina Expands Medicaid Managed Care to Encompass Behavioral Health, I/DD Populations
07/10/2025
Grace Taylor, MS, MA
North Carolina's Medicaid overhaul takes a major step forward as tailored managed care plans finally launch for residents with complex behavioral health and developmental needs.
North Carolina's Medicaid overhaul takes a major step forward as tailored managed care plans finally launch for residents with complex behavioral health and developmental needs.
North Carolina's Medicaid...
07/10/2025
First Report Managed Care
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