Tuesday, September 1, 2026 - Updated Daily
Tuesday, September 1, 2026 - Updated Daily
Medicare Advantage plans are paid through risk adjustment. The government sends each plan a fixed monthly amount per enrollee, and that amount rises when the enrollee’s record contains certain diagnosis codes. The system assumes sicker…
Medicare Advantage vs traditional Medicare is no longer a beneficiary-choice discussion alone. It is a market-structure issue affecting referral patterns, hospital utilization, post-acute length of stay, network access, risk-bearing arrangements, and the financial viability of…
For years, healthcare operators have heard the same directive: move from volume to value. The future of healthcare reimbursement models, however, will not be settled by a slogan or a single CMS demonstration. It will…
Medicare post-acute care (PAC) reimbursement is increasingly driven by stricter federal spending controls, closer Medicare Advantage (MA) utilization oversight, and limited rate increases. Current policy priorities center on value-based accountability, shifts to lower-intensity care settings,…
A review of Medicare Advantage prior authorization starts with an operational reality: a clinically appropriate service can be delayed, redirected, or denied before the provider ever has an opportunity to deliver it. For hospitals, skilled…
The practical question is not whether value-based care affects operators. It already does. The more consequential question is whether an organization recognizes the change early enough to redesign how it manages referrals, clinical performance, workforce…
Healthcare executive, consultant, and author covering post-acute care, senior living, and the economics behind both - for 30+ years.
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