302: CMS announced the 2027 MA final rate. What do payers and providers need to know?

About this episode

The episode discusses the implications of the 2027 Medicare Advantage final rate announcement for payers and providers.

CMS continues to pull on the levers it has at its disposal to rein in national healthcare spend, including rulemaking around Medicare Advantage. In April, CMS announced the final rate for MA plans for CY2027, after a controversial proposed rule generated animated pushback — and a fair bit of panic — among payers. In this episode, host Abby Burns speaks with Alex Balmes, Vice President of Actuarial Services at Optum, to unpack what did — and didn’t — end up in the final rate announcement, and what that signals for the future of the Medicare Advantage program. Together, they explore the components of the final rate that are most important for payers and providers to pay attention to, respectively, and why. Also in the 2027 final announcement, but not discussed in this episode: four measures are being added or updated in Star ratings calculations (Colorectal Cancer Screening; Care for Older Adults – Functional Status Assessment; Concurrent Use of Opioids and Benzodiazepines (COB); Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)) and three are being removed (Care for Older Adults – Pain Assessment, Medication Reconciliation Post-Discharge…

People in this episode

Host: Abby Burns

Guest: Alex Balmes

Topics covered

• Medicare Advantage
• healthcare spending
• rate announcement
• payers
• providers
• health policy

Keywords

• CMS
• Medicare Advantage
• healthcare
• rate announcement
• payers
• providers
• health policy
• Optum

Mentioned in this episode

Organizations: CMS, Optum

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