Medical Economics December 10, 2025
Key Takeaways
- Managed care is shifting towards strategic recalibration, focusing on fundamentals with precision to address margin pressures and cost volatility.
- Providers must assert their value through data-driven performance, emphasizing impact on Stars, risk scores, and total cost of care.
- The burden of justifying value is shifting to providers, requiring proactive negotiation strategies to avoid commoditization.
- Strategic imperatives include understanding contract economics, framing performance economically, and preparing for potential conflicts.
The burden to justify value is being shifted from the insurer to the provider.
Managed care is at an inflection point.
Across the industry, payors are showing steady revenue growth, but margins are under pressure, cost trends are volatile, and the mechanisms that have long underpinned managed care...
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