Insights & Perspectives

AI is becoming a bigger part of the conversation around how health plans operate, but the real opportunity is in turning that technology into practical, measurable improvements. We’re excited to see MCRA Member Simplify Healthcare continuing to expand in this space with the growth of its Payer AI Platform. The company’s latest announcement highlights its focus on helping health plans connect data, workflows and intelligent automation across key areas of the payer enterpris

Discover why Q3 is a critical window for healthcare payers to reduce configuration debt, prevent claims rework, and lower costs before January volume hits.

Avalere Health explains some of the details of Medicaid work requirements, including how activities of daily living may factor in and some of the leeway states have in how they are applied.

Medicaid work requirements are expected to start January 2027, with narrower exemptions than anticipated. Learn how life sciences companies, plans, and providers can support patients.

CMS will be re-calculating 2027 QBP ratings following the May 2026 Clover ruling. Avalere Health experts share insights on potential future directions for the MA Star Rating program.

Part B drugs will be subject to IRA price negotiation for the first time in 2028, introducing new payment uncertainties for Medicare Advantage plans.