Healthcare Payers / Providers

While last night’s widely telegraphed Star Ratings delivered clear winners [HUM, CLOV, Devoted Health (pvt)] and losers [ALHC] (and a mixed bag for UNH, CVS, ELV, CNC, and MOH), potentially underappreciated methodological choices by CMS…

Despite lopsided stakeholder opposition, we continue to expect CMS to finalize largely as initially sought its CY27 proposal cutting Medicare reimbursement for 337 common non-contrast imaging procedures at grandfathered off-campus hospital outpatient departments (HOPDs) while…

Following yesterday’s oral appellate arguments over HUM’s challenge to Medicare Advantage (MA) risk adjustment-related audit rules, we believe a majority of the three-judge panel is likely to side with the company and the lower court…

With CMS likely to release its final CY27 Medicare Hospital Outpatient Prospective Payment System (OPPS) rule in early November, we continue to expect a substantial cut to Medicare payment for 340B-acquired drugs administered in participating…

This afternoon’s White House announcement of additional Obamacare anti-fraud actions does not change the direction of the ACA reset underway over the past year, nor our expectations for 2027 and 2028. While the actions appear…

Based on our review of stakeholder comments to CMS’s proposed CY27 Medicare home health (HH) payment rule, we continue to see an avenue for HH-specific upside in the final regulation due in late October/early November…

With the November elections less than two months away, we assess how different congressional outcomes could reshape the healthcare legislative agenda for hospitals, dialysis centers, value-based care (VBC) providers, skilled nursing facilities (SNFs), post-acute care…

With the November elections less than two months away, we assess how different congressional outcomes could reshape the healthcare legislative agenda for health insurers, pharmacy benefit managers (PBMs), 340B contract pharmacies, and health savings account…

Our review of stakeholder feedback on CMS’s CY27 Medicare payment rule for dialysis centers [DVA, FRE.DE, private US Renal Care and Innovative Renal Care] leaves us expecting a final rule similar to the June proposal,…

The pending Contract Year (CY) 2028 Technical and Policy Changes proposal for the Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC, CLOV, MOH] and MA-exposed providers [AGL, ASTH] could be relatively more consequential…