Healthcare Payers / Providers

For-profit hospitals [THC, HCA, CYH, ARDT, UHS] received some expected positive news – though the magnitude surprised us – in the CMS’s proposed CY27 hospital outpatient prospective payment system (OPPS) rule. Ambulatory surgery centers (ASCs)…

Home health (HH) agencies [PNTG, BTSG, AVAH, UNH, ADUS, Elara] received a favorable surprise in CMS’s proposed CY27 Medicare HH reimbursement rule, released Wednesday. The regulation includes: A temporary 3% recoupment adjustment, matching the final…

We present our quarterly outlook on the key catalysts for health insurers and providers. Entering 3Q, the negative policy bias that dominated 1H26 has eased as payers appear to have priced plans appropriately and medical…

Senate HELP Chairman Bill Cassidy’s (R-LA) recently introduced 340B Drug Pricing Integrity and Affordability for Patients Act raises threats to 340B contract pharmacies (both brick-and-mortar and mail-order) [CVS and private Walgreens, and to a much…

CMS’s CY27 proposed Medicare end-stage renal disease (ESRD) payment rule is likely to leave dialysis providers [DVA, FRE.DE, private Innovative Renal] somewhat disappointed. The agency declined to extend the transitional drug add-on payment adjustment (TDAPA)…

CMS informed Medicare Advantage (MA) insurers [HUM, UNH, CVS, ELV, CNC, ALHC, MOH, CLOV] that it is voluntarily recalculating their CY26 Star Ratings, which determine CY27 Quality Bonus Payments (QBP). Under the agency’s approach, released…

Last week’s ACA-related court ruling permanently, which enjoined key portions of the CY25 Obamacare regulation, may initially reassure insurers [OSCR, CNC, ELV] and hospitals [HCA, THC, CYH, UHS, ARDT] about certain enrollment-related program integrity headwinds….

While Medicaid and ACA enrollment concerns have dominated the policy overhang for hospitals this year, Medicare-related risks could move higher on investors’ radar with the release of CY27 hospital outpatient prospective payment system (OPPS) proposed…

CMS’s long-awaited interim final rule implementing the One Big Beautiful Bill’s (OBBB) Medicaid Community Engagement (CE) requirements largely aligns with our expectations that CMS would defer to states on program design and implementation, which we…

Last week’s federal court ruling in favor Clover Health (CLOV) against CMS injects fresh uncertainty into the Medicare Advantage (MA) Star Ratings and quality bonus payment framework [UNH, HUM, ELV, CVS, ALHC, CNC, MOH]. While…