Managed Care Resource Alliance (MCRA)

Under CMS's new Medicaid work rule, a qualifying medical condition alone won't exempt enrollees. They must also show impairment in a daily living activity.

Eric Levine, M.P.H., principal at Avalere Health, explains why a diagnosis alone won't exempt someone from the Medicaid work requirements that go into effect in 2027.

CMS's new interim rule sets an 80-hour monthly work requirement for many Medicaid enrollees but leaves states some latitude on setting medical exemptions and verification processes.

While health plans invest aggressively in member experience, care management, and digital engagement, the communications infrastructure supporting all of it continues to operate as a cost center rather than a strategic capability.

And what has it achieved? The meaning and achievements of managed care change with the times, the context, the goals — and in the eyes of the beholders.

To prepare for CMS’ new risk adjustment data validation (RADV) strategy, Medicare Advantage plans must take a coordinated, organization-wide approach.

The authors provide a detailed framework for assessing the adoption of artificial intelligence.

Facing a variety of financial pressures, health plans need to take a measured approach to identify supplemental benefit strategies that facilitate their success.

Michael Lutz, managing director of Avalere, shares his prediction for the year.

Because of the recent decline in the star ratings published by CMS, it is critical for Medicare Advantage plans to achieve high star ratings.

Artificial intelligence stands out as a particularly promising solution to the challenges of improving health literacy.

COBRA coverage is not currently considered creditable coverage, so some seniors face Part B penalties. That needs to change.