Insights & Perspectives

When a health plan’s AI isn't working, the instinct is to blame the technology. Wrong model, wrong vendor, wrong use case. But in most cases, the AI itself isn't the problem. The problem is what the AI was built on top of, and the fact that nobody fixed that first. To understand why, it helps to understand where your plan actually sits today, and what it truly takes to move forward. That's what the CX Maturity Scale was built to show.

Medicaid is entering a period of significant change. New work requirements, shifting financing models, rising healthcare costs, and growing pressure on state budgets are creating new challenges for managed care organizations, while the need to improve access, experience, and outcomes remains as important as ever. MCRA Members GoMo Health and Avalere Health team up to offer insights on the Medicaid policy changes and how managed care organizations can respond.

Explore how CMS could use behavior-informed care to improve chronic disease management through personalized support, patient engagement, behavioral science and continuous interventions.

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.

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.