Blog
Employer healthcare analytics help health plans improve employer group performance Every renewal season, health plans meet with employers to discuss premium increases, review utilization trends, summarize claims experience, and highlight network strength and…
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The decision by the Centers for Medicare & Medicaid Services (CMS) to recalculate certain Medicare Advantage Star Ratings has generated understandable attention across the industry. I recently shared my perspective in Health Payer…
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Closing care gaps has become a core focus for Medicare Advantage plans for good reason. Gap closure directly impacts Star Ratings, quality performance, and reimbursement. It’s measurable, actionable, and tied to clear programmatic goals. For many Medicare…
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Social determinants of health (SDOH) have become one of healthcare’s biggest strategic priorities, but many organizations still struggle with how to operationalize social risk data in a measurable, scalable way. In a recent HIMSSTV…
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Medicare Advantage organizations are facing growing pressure to improve quality outcomes, optimize financial performance, reduce compliance risk, and deliver better member experiences, all while managing increasingly complex operations. Yet many health plans still rely on disconnected…
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Most Medicare Advantage revenue loss doesn’t show up where finance teams expect it. It’s not a single variance in a report or a clear miss against budget. It’s smaller, compounding gaps spread across risk adjustment, quality performance, and medical cost that…
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Health plans are navigating rising medical costs, intensifying regulatory demands, margin pressure, evolving member expectations, and growing operational complexity, all while being expected to improve outcomes, affordability, and experience. These challenges and expectations…
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Growth in Medicare Advantage has become increasingly difficult to sustain. Acquisition costs are rising, competition is intensifying, and members are more willing than ever to switch plans in search of better value. A study found that 15.6% of Medicare…
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Healthcare outcomes have never mattered more, and achieving exceptional performance has never been harder. Many mid-to-large health plans are below the 4-Star threshold in Medicare Advantage (MA). While that level of performance may seem acceptable, it can cost health plans millions. Why the 4-Star threshold is a…
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OpsIgnite 2026 brought together operational leaders from across the Blues ecosystem for four days of candid conversation, practical insights, and forward-looking strategy, all centered on a shared goal: turning complexity into coordinated action. Across…
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