The final 2027 Medicare Advantage Rate Announcement provided some relief to a still displeased industry.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the final 2027 Medicare Advantage Rate Announcement. It provided some relief to a still displeased industry.

Key Takeaways:

Medicare Advantage (MA) plans got a bit of relief from CMS initial proposal of a 0.09% rate hike in 2027.

The final adjustment will be 2.48%.

CMS gave in a bit to the industry and pulled back on another proposed risk adjustment model change.

It will follow through on some risk adjustment reform by barring unlinked charts (those not connected to an actual provider encounter) in most cases.

The rate hike is far below what has been seen in terms of utilization.

The hike will mean about $13 billion in new dollars to MA plans, up from under $1 billion proposed.

But because most plans do not have aggressive risk adjustment practices, most plans will see an increase closer to 4%.

Big plans will bear the burden of most of the unlinked chart reform.

The 2027 modest hike is yet another sign that CMS will be stingier on rate dollars in the future.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

The final 2027 Medicare Advantage and Part D rule cemented some major changes in Star Ratings that will have far-reaching revenue impacts.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the final 2027 Medicare Advantage and Part D rule. It cemented some major changes in Star Ratings that will have far-reaching revenue impacts.

Key Takeaways:

The 2027 Medicare Advantage and Part D rule was finalized with major Star Ratings changes.

The EHO4all health equity reward was retroactively rescinded, and the Reward Factor will be kept.

Thirteen of 14 measure retirements were finalized, most of which are easy-to-hit operational measures.

A new Depression Screening measure was adopted as well.

The effect of the measure changes means clinical measures now are weighted almost half of overall star ratings, with CAHPS and HOS measures over a third.

At least 25% of contracts are expected to lose a half Star rating, with others seeing their performance drop to put higher ratings out of reach.

Other reforms adopted include repealing many health equity mandates, reining in and reforming supplemental benefits, and codifying many Part D changes.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

Since the feds won't act, states are increasingly passing healthcare reform legislation to control costs.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses a series of state healthcare laws and bills. Since the feds won't act, states are increasingly passing healthcare reform legislation to control costs.

Key Takeaways:

Trump 47 has pushed forward on a series of healthcare regulatory reforms. Kudos, but Congress refuses to truly act.

Therefore, states are increasingly getting into the healthcare reform game.

While states are preempted on self-insured and Medicare coverage, they are getting creative to impact price and reduce costs.

Many are pushing through hospital price caps in various forms.

Other states have set up statewide accountability costs to limit overall healthcare cost growth.

Many states have passed transparency laws.

Reform at the state level is in progressive as well as conservative states.

Increasingly states see the problem and do not view controlling price negatively.

But Congress must act to have true impact and so we don't have a patchwork system.

Site neutral payments, uniform pricing, and addressing consolidation are among the reforms I view as crucial.

Connect With Marc:

Marc on LinkedIn

Marc on Twitter

THL Podcast

Resources:

THL's Newsfeed

THL's Blog

The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance