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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.
Payer
Strategy
Reducing Medical Loss Ratio and Enhancing Member Care
Discover how BCBS organizations can reduce Medical Loss Ratio and enhance member care while managing rising healthcare costs and growing regulatory demands. This exclusive eBook by Emids offers actionable strategies across five key pillars—operational efficiency, MLR optimization, interoperability, member engagement, and compliance. Learn how to optimize costs, improve member satisfaction, and drive sustainable growth.
Payer
Strategy
Sustainable Cost Optimization for Payers: Unlocking Efficiency and Growth in Healthcare
Healthcare payers face mounting challenges balancing rising costs, regulatory demands, and member expectations. Learn how to optimize Medical Loss Ratios (MLR), modernize outdated systems, and consolidate data for smarter decision-making. Packed with insights from Emids’ 30+ years of healthcare transformation expertise, this eBook provides the tools to future-proof your organization and drive sustainable growth.
Strategy
Seven Compelling Healthcare Conversations
With our 7th Annual Healthcare Summit less than a month away, we’ve assembled a pre-read packet of the Seven Most Compelling Healthcare Conversations we’ll be facilitating with guests near and far. Take a few minutes below to get a taste of what’s in store, and be sure to join the conversation (and hear some of the […]