01
Member-Centered Revenue Integrity & ACT Governance
Improving documentation accuracy, encounter validation, and alignment between care and revenue processes.
The Five Levers That Win in CY2027
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At A Glance
Where to focus to improve Medicare Advantage performance in CY2027
Medicare Advantage has entered a more operationally driven phase, where performance is increasingly shaped by how effectively plans manage revenue, cost, Stars, and product strategy at scale.
As rate dynamics evolve and regulatory expectations tighten, historical levers such as enrollment growth and benefit design alone are no longer sufficient to sustain margins. Plans must now focus on execution, control, and alignment across core operational drivers.
This report outlines five areas where leading plans are taking action to improve performance and create measurable impact heading into CY2027.
02
Engineered Medical & Pharmacy Cost Discipline (VBC-First)
Targeting high-cost areas through focused interventions and value-based approaches.
03
Stars & Retention as Financial Infrastructure
Embedding quality, experience, and retention into ongoing operations.
04
Rigorous Operating Cost Management & Claims Efficiency
Improving claims processes, reducing cycle times, and managing operating costs more effectively.
05
Operationally Grounded Product & Bid Strategy
Aligning product design and pricing with operational performance and member needs.