We supported an established health plan in crafting a successful proposal response to retain access to three existing service areas and gain access to two additional Medicaid regions in a state with a large beneficiary population.
Featured Videos
Trusted Partnership
Amidst changing regulatory, technology, and market dynamics, health plans partner with Avalere to ensure their strategy and operations are aligned to achieve long-term goals.
Video
AI for Health Plans and the Future of Clinical Data
In a three-part video series, Avalere and partners explore how plans can employ artificial intelligence to optimize clinical data management. In the first video, we discuss the regulatory and market dynamics around clinical data and implications for health plans; the second video explores how plans are operationalizing enterprise clinical data; and the third video details real-world examples of how AI can streamline data management and support plans’ decision making.
How Can We Help?
Engage an Expert Today.
Engage an Expert Today.
Featured Expertise
Related Content
Coverage and Payment
Health Plans 2030: Shifting Clinical Care Delivery
RWE and Patient-Centered Outcomes
Get the Most Out of In-Home Assessments to Retain Members and Improve Health Outcomes
Federal and State Policy
Inside the Latest RADV Regulatory Developments
Part B Negotiated Drug Prices: How MA Plans Should Prepare
Part B drugs will be subject to IRA price negotiation for the first time in 2028, introducing new payment uncertainties for Medicare Advantage plans.
Post-Clover and 2027 QBP Re-Calculation: What Could Be Next for MA Stars?
CMS will be re-calculating 2027 QBP ratings following the May 2026 Clover ruling. Avalere Health experts share insights on potential future directions for the MA Star Rating program.
How Can Manufacturers, Payers, Providers, and Patient Groups Prepare for Medicaid Work Requirements?
Stakeholders can prepare for the upcoming implementation of federal Medicaid community engagement requirements, which are planned to go into effect January 1, 2027.
Clover Health Wins MA Stars Lawsuit: What’s Next?
Avalere Health experts discuss the recent court decision on Clover Health's Medicare Advantage Stars results lawsuit, and what health plans should be assessing for future potential impacts while appeals and next decisions play out.
Predictably Unpredictable: Medicare Risk Adjustment
Medicare risk adjustment is shifting. In five minutes, Avalere explains policy changes, RADV expansion, and how evolving models may affect payments and market strategy.
How can MCOs Prepare for Medicaid Community Engagement (Work) Requirements?
MCOs have an opportunity to prepare for—and mitigate—the impact of Medicaid work requirements, which are expected to go into effect in January 2027.
The Impact of CMS and HHS Rules on Responsible AI Use
CMS and HHS regulations are shaping AI use in health plans, driving transparency and accountability, and speeding responsible adoption across an increasingly automated system.
What’s Shaping Healthcare Right Now?
Introducing On the Record: Health Plan Perspectives—A rapid-fire series delivering expert clarity on major CMS and HHS rules. In five minutes, get the insights, implications, and decisive perspective leaders need now.
Bridging the Gap: The Future of GLP-1 Coverage in Part D
The recent delay of the BALANCE Model and the GLP-1 Bridge extension highlight the challenges of expanding GLP-1 access in Part D.
2027 Part D Risk Adjustment Changes Will Alter Plan Payment
Finalized updates to the Part D risk adjustment model to further separate MA-PDs and PDPs will change plan payments for certain conditions.
Please wait ...