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Strategy
Managing the Margin Reset in Medicare Advantage
The CY2027 Advance Notice isn’t a routine rate update. A near-flat base update, normalization pressure, revised sources-of-diagnoses policy, and encounter-based validation are collectively narrowing revenue elasticity. For payer executives, this isn’t a compliance year. It’s a margin discipline year. This guide outlines the structural shifts required to protect earnings across risk adjustment governance, medical cost precision, pharmacy economics, STARS stability, and bid strategy in a maturing MA market.
Strategy
The 10 Margin Levers Defining MA Performance in CY2027
Medicare Advantage is entering a margin maturity phase. Rate pressures are intensifying, audit scrutiny is tightening, and the gap between top-quartile and average plans could widen by 300 to 400 basis points over the next 24 months. Isolated fixes won’t close that gap. This guide identifies the ten structural levers across revenue integrity, medical cost redesign, pharmacy economics, and STARS stability that separate plans preserving margin from those facing compression. It also maps Emids’ 90-day path from margin pressure to margin precision.
Interoperability
CMS-0057: The Interoperability Imperative
CMS-0057 is redefining how health plans operate, not just what data they expose. With 2026 reporting requirements approaching and full API enforcement in 2027, payers face a critical architecture decision: build for compliance alone or invest in infrastructure that scales. This guide breaks down why tactical API implementations create long-term risk, and how a unified, FHIR-first approach turns regulatory investment into a foundation for automation, analytics, and AI.
Artificial Intelligence
Automation
Modernizing Claims Operations with Agentic Automation
Payers are dealing with rising claim volumes, more complex cases, and pressure to reduce administrative costs. Even with solid rules and bots, 15–20% of claims miss first pass adjudication and stall in pended queues. Unstructured data (attachments, notes) and constant configuration changes fuel manual rework, longer cycle times, and staff burnout—eroding member and provider experience.
Artificial Intelligence
Closing the AI ROI Gap in Healthcare
Healthcare organizations are investing heavily in AI to improve operations, cut costs, and enhance patient care. But despite the promise, most initiatives fail to scale. Projects stall in pilots due to limited workflow integration, fragmented platforms, and the challenge of proving real business impact. This ebook explores why so many AI efforts fall short—and what leading healthcare organizations are doing differently to unlock real ROI.
Digital Transformation
Life Sciences
Unlocking Trusted Digital Transformation in Life Sciences
Life sciences organizations are advancing digital initiatives to accelerate innovation in R&D, diagnostics, and regulatory processes. But despite significant investment in AI, ML, and cloud platforms, many efforts stall due to fragmented data, regulatory complexity, and a lack of alignment between digital tools and clinical workflows.
Artificial Intelligence
Data & Analytics
AI Pilot to Production: 6 Barriers Preventing Payers from Scaling AI
Artificial intelligence (AI) holds tremendous potential for healthcare payers but realizing that potential hinges on one crucial factor: data readiness. In a recent webinar hosted by Emids, ‘Modernizing Data Foundations for AI: How to Accelerate Value from Legacy to Cloud’, industry leaders from Snowflake, BHI and Emids came together to explore why many payer organizations are […]
Member Engagement
Payer
Strategic Wellness Platforms and ROI: A Blueprint for Success
Rising healthcare costs and chronic illness are shrinking payer profits. This has payers exploring wellness platforms as a path to better health outcomes and long-term gains, but many payers struggle to see ROI. The market is crowded—with established brands, niche apps, and influencers all competing for attention. To succeed, insurers must define a clear, strategic […]
Artificial Intelligence
Data & Analytics
Modernizing Data Foundations for AI: How to Accelerate Value from Legacy to Cloud
Outdated data systems can limit the potential of AI. Join Emids and industry experts to explore practical strategies for moving from legacy systems to cloud-native platforms. Learn how to strengthen your data foundation, streamline operations, and realize meaningful value from AI. Watch the webinar to see how healthcare organizations are closing the gap between strategy and execution.
Artificial Intelligence
Data & Analytics
Don’t Let Bad Data Sabotage Your AI Goldmine
The successful implementation of AI in healthcare presents several key hurdles that enterprises must overcome to unlock their full potential. This is especially true for sectors like healthcare, where data security and integrity are paramount. Enterprises face a few primary hurdles when embarking on AI initiatives, which can include securing buy-in and willingness to invest […]
Artificial Intelligence
Data & Analytics
Payer
Payers: Is Your Data Ready for AI?
Payers are handling massive volumes of data, but few are truly prepared to harness its power for AI transformation. This eBook offers a comprehensive look into how payer organizations are navigating the challenges of AI adoption and what it takes to establish a strong data foundation. Unlock expert insights from Emids and start building a trusted foundation for AI in your organization.
Member Engagement
Payer
Digital for All: Why Accessibility Is the Missing Link in Member Engagement
It’s no secret amongst payer executives that digitally engaged members are more likely to schedule preventive care appointments, adhere to prescribed treatments, and are more likely to avoid costly emergency interventions and experience better health outcomes, overall. This enables payers to also reap substantial benefits – particularly in efficiency, cost management, and long-term profitability. As […]