Post by Accelirate HLS Solutions

Payers still control the payment math. Providers are starting to test network leverage.   CMS proposed paying 340B-acquired drugs at ASP minus 33.4% under the CY 2027 OPPS/ASC proposed rule.   The rule affects about 3,500 hospitals and 6,400 ASCs, with CMS estimating a $4.55B reduction in Original Medicare drug payments and $1.15B less in beneficiary drug payments in year 1.   CarolinaEast Medical Center exited Blue Cross Blue Shield of North Carolina’s Medicare Advantage network on July 1, citing payment policies, denials, and reimbursement delays.   The hospital also extended UnitedHealthcare Medicare Advantage participation only through Dec. 31, 2026.   KFF’s $13.4B Medicare Advantage quality bonus pool shows the financial advantage still sits with plans.   But CarolinaEast shows providers are beginning to use network participation as a cash-flow lever, not just a contracting issue.   CFOs should watch UnitedHealth Group’s July 16 Q2 results for signals on MA margin, utilization pressure, prior authorization changes, and provider negotiation tone.   Follow Accelirate HLS Solutions for the next Payer vs Provider Scoreboard.   #HealthcareFinance #MedicareAdvantage #RCM #CFO #HealthcareLeadership Isel | Jonathan | Aaron | Cletus | Bailey | Rajshree | Freguens | Madhu