Insights & Perspectives

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.

New Medicaid community engagement requirements are on the horizon, bringing significant operational and compliance considerations for Medicaid managed care organizations (MCOs). Read the full analysis to learn how MCOs can position themselves for success in a rapidly evolving Medicaid landscape.

Avalere Health shares the third episode of One the Record. Episode 3 examines the evolving world of Medicare risk adjustment, where shifting regulations, audit activity, and payment methodologies continue to create both challenges and opportunities for health plans. Learn what’s driving the uncertainty, what organizations should be watching, and how to prepare for what comes next.

Avalere Health shares the second episode of One the Record—A rapid-fire series delivering expert clarity on major CMS and HHS rules. In five minutes, get the insights, implications, and decisive perspective leaders need now.

Tune into a bonus episode of On the Record where Avalere Health experts discuss the recent court decision on Cover Health's Medicare Advantage Stars results lawsuit, and what health plans should be assessing for future potential impacts while appeals and next decisions play out.