Sept. 4 - New evidence that major payers game MA

Sept. 4 - New evidence that major payers game MA | CMS tweaks AHEAD model

Florida seeks to eliminate vaccine mandates, including for children; CMS tweaks AHEAD all-payer model for states; Medicare saved record $2.4B from largest accountable care program last year

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Daily Dive

Sept. 4, 2025 | Today’s news and insights for healthcare leaders

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UnitedHealthcare, Humana are gaming Medicare Advantage risk adjustment, analysis finds

The research from the Alliance for Community Health Plans adds to existing evidence that major insurers are unfairly profiting from MA’s risk adjustment system, driving billions of dollars in unnecessary costs.

Florida seeks to eliminate vaccine mandates, including for children

State Surgeon General Joseph Ladapo says the state health department can abolish some vaccine requirements while others need lawmakers’ approval.

CMS tweaks AHEAD all-payer model for states

The model will now run for one additional year and require providers to assume more downside risk.

Marshall Health Network’s chief population health officer talks data, value-based care and new opportunities with AI

Data Intelligence is enabling Marshall Health to enhance primary care advocacy across its communities.

Medicare saved record $2.4B from largest accountable care program last year

ACOs are also improving in quality, according to the CMS data. Still, the Medicare Shared Savings Program has struggled with waning provider buy-in.

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