Healthcare Payers / Providers

Below are our thoughts on this afternoon’s HHS release of the National Kidney Dialysis Plan [DVA, FRE.DE, private US Renal, Innovative Renal Care]: The stock reaction [DVA, FRE.DE] seems overblown, especially given the limited near-term…

Questions remain about potential CY28 policy pressures on Medicare Advantage (MA) insurers [HUM, ALHC, CLOV, UNH, CVS, ELV, CNC, MOH] and value-based care providers [AGL, ASTH, PRVA, EVH, private Aledade], particularly Star Ratings, risk adjustment,…

Recent developments are raising the risk of future changes to the No Surprises Act, with implications for specialty physicians and hospitals [NUTX, private TeamHealth, Radiology Partners, SCP Health] and commercial insurers [UNH, CI, ELV, CVS]….

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…