KLA Healthcare Consultants

01/21/2026

Medicare MIPS Reporting in 2025: Why It Matters (and What to Do If Your EMR Can’t Submit) 🩺📊

If you participate in Medicare and MIPS reporting is part of your world, here’s the not-so-small detail many practices overlook:

If MIPS requirements are NOT met, Medicare reimbursement can be reduced by up to 9% on Part B payments. 😬 If MIPS IS met (or exceeded), clinicians may avoid penalties and earn positive payment adjustments.

That 9% might sound theoretical… until it isn’t.

For large systems, a MIPS penalty can sting.

For small and solo practices, it can hurt a lot more. 💸

Smaller practices often operate on thinner margins, have fewer administrative staff, and don’t always have an EMR that automatically submits data to Medicare. That doesn’t mean MIPS doesn’t apply — it just means the pathway looks different.

CMS allows clinicians to submit MIPS data through approved third-party platforms when an EMR can’t do it directly. 🙌

Below are CMS-approved options commonly used by practices, with a quick sense of cost and complexity:

MDinteractive
A long-standing CMS Qualified Registry
Approximate cost: $389–$499 per clinician per year depending on categories submitted
Good for practices wanting straightforward submission with strong support
Website: mdinteractive.com

Mingle Health (MIPS Solutions)
Registry with dashboards, scoring tools, and hands-on guidance
Approximate cost: about $49 per provider per month (billed annually)
Good for practices that want year-round tracking and coaching
Website: minglehealth.com/products-services/mips-solutions

PRIME Registry
Qualified Clinical Data Registry (QCDR)
Approximate cost: $460–$515 per clinician per year
Good for small to mid-size practices wanting a clean, simple reporting dashboard
Website: primeregistry.org/reporting

Patient360
Registry and QCDR with advanced analytics and specialty measures
Cost varies (custom quote required)
Good for practices with more complex data or specialty needs
Website: patient360.com

Why this matters especially for small practices 👇
Smaller groups often feel the MIPS pinch more sharply because:
• A 9% cut hits a smaller revenue base harder
• There’s less room for billing errors or missed deadlines
• Administrative time = real lost patient care time

The right reporting platform can mean the difference between:
“Why is Medicare paying us less this year?” 😵‍💫
and
“Glad we handled that proactively.” 😌

KLA Healthcare helps practices:
• Understand MIPS requirements in plain English
• Evaluate which reporting platform fits their size and workflow
• Coordinate billing, compliance, and reporting so nothing falls through the cracks

Because doctors should spend more time with patients — not wrestling spreadsheets at midnight. ☕📋

If your EMR doesn’t submit MIPS data directly, that doesn’t mean you’re stuck — it just means you need the right path forward.

Questions? We’re happy to help you think it through.

01/21/2026

Healthcare is changing—not because clinicians care less, but because the system now asks them to be healers, documentarians, coders, compliance officers, data-entry specialists, and occasionally mind-readers… all before lunch 😅📋.

At KLA Healthcare, we work closely with clinician offices every day, and we see the pressure firsthand. Most clinicians want nothing more than to think deeply, listen carefully, and partner meaningfully with their patients. Instead, many are juggling prior authorizations, EHR alerts, quality metrics, audits, billing rules, and regulatory requirements—often while being expected by payors to see four to six patients an hour ⏱️.

It’s a lot. And that’s putting it mildly.

This reality calls for smarter workflows, not harder ones—and maybe a little grace for everyone involved.

One of the most promising shifts we’re seeing is the thoughtful use of modern tools—such as AIs including ChatGPT and Grok—to help patients come to visits better prepared, more informed, and more engaged in their own care 🤝.

When clinicians encourage patients to advocate for themselves using structured preparation tools, something powerful happens.

A prepared patient helps the clinician focus faster. A concise written summary allows the clinician to quickly scan key information, confirm accuracy, and apply their expertise where it matters most 🧠. Instead of spending valuable minutes reconstructing medication histories from memory or decoding “that little white pill,” clinicians can engage in higher-level decision-making and patient education.

This is not about replacing clinical judgment. It’s about enhancing the visit—and preserving a little sanity along the way.

A prepared patient helps the clinician focus faster. A concise written summary allows the clinician to scan key information quickly, confirm accuracy, and apply their expertise where it matters most 🧠. Instead of spending valuable minutes reconstructing medication histories from memory or decoding “that little white pill,” clinicians can engage in higher-level decision-making and patient education.

This approach also aligns with good compliance and risk management practices ⚖️. Encouraging patients to understand their medications, risks, and benefits supports informed consent and shared decision-making—both increasingly emphasized by regulators, accrediting bodies, and payors.

Clinicians may already know that certain medications carry risks or interactions and have determined that a particular regimen represents the best risk-benefit balance for a patient. When patients come prepared with thoughtful questions, it opens the door to calm, transparent conversations rather than rushed explanations. Education builds trust. Trust improves adherence. Adherence improves outcomes 🌱.

From a practice-management standpoint, engaged patients can also reduce downstream friction—fewer follow-up calls, fewer portal messages that begin with “Sorry to bother you…,” and clearer documentation of patient understanding 📉.

At KLA Healthcare, we encourage clinician offices to see patient advocacy tools as allies, not adversaries. Teaching patients how to prepare responsibly for visits—through written checklists, structured summaries, or AI-assisted organization—supports efficiency, quality care, and sustainability in a system that is asking clinicians to do more than ever.

Our suggestion: prepare a one-page patient handout that supports your patients in using AI to compile their symptoms, questions, medications, etc. for each visit. It will help them and you for the most meaningful visit.

Modern healthcare works best when clinicians are supported, patients are informed, and systems are designed for collaboration rather than burnout ❤️.

That’s where thoughtful leadership—and smart infrastructure—make all the difference.

01/19/2026

Today we honor the legacy of Dr. Martin Luther King Jr.—a leader who reminded the world that dignity, fairness, and respect are not abstract ideals, but daily practices.

Dr. King believed that systems matter. He understood that when systems are unjust, overwhelmed, or poorly designed, people suffer—even when individuals within those systems are doing their best. That insight still resonates today, including in healthcare.

At KLA Healthcare, we see Dr. King’s legacy reflected in the quiet, often unseen work of building systems that support people rather than exhaust them. Clear rules. Fair processes. Ethical leadership. Respect for those doing the work and those being served.

Honoring Dr. King means continuing to ask hard questions with humility, improving systems with integrity, and remembering that behind every policy, regulation, and workflow is a human being deserving of dignity.

May we lead with clarity, compassion, and courage—especially when the work is complex and the stakes are high 🕊️.

01/15/2026

Prior Authorization Comes to Traditional Medicare And Why Providers Are Seeing It Everywhere 👀📋

For decades, Traditional (Fee-for-Service) Medicare was considered the calm harbor of healthcare reimbursement — fewer hoops, fewer forms, and far less prior authorization than its commercial and Medicare Advantage cousins.

That era is officially ending.

Beginning in 2026, CMS will roll out a prior authorization pilot program in six states, introducing utilization management requirements into traditional Medicare for the first time at scaleat scale While the pilot is geographically limited, its ripple effects are already being felt nationwide — including in Medicare Advantage plans and commercial insurance, even outside the pilot states.

If it feels like prior authorization is multiplying faster than rabbits in springtime… you’re not imagining it. 🐇📄

Why Is This Happening? (The Legislative Backstory)

The Push to Reduce “Waste, Fraud, and Abuse” 💸

CMS has long cited concerns that a meaningful portion of healthcare spending goes toward services that may be unnecessary, duplicative, or low-value. Historically, Medicare addressed this through post-payment audits and enforcement actions.

The new approach?
Move the review before the service, notidentified by CMS after.

Enter the WISeR Model (Wasteful and Inappropriate Service Reduction). This pilot allows CMS to test whether prior authorization can reduce questionable utilization without harming patient outcomes.

In theory, it’s about better stewardship of taxpayer dollars.
In practice, it means… more paperwork. 📑😅

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What the Medicare Pilot Actually Does

Starting January 1, 2026, providers in six states will need prior authorization for a defined list of services that CMS has identified as having a higher risk of inappropriate use.

A few key points worth emphasizing:

Coverage rules do not change
Appeal rights remain intact
Reviews are conducted by licensed clinicians (with technology assisting, not replacing them)
Providers may choose between pre-service authorization or post-service medical review

CMS frames this as a “measured test.” Providers often experience it as a “measured test of patience.” 😬

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Why This Isn’t Staying in Just Six States

Even though the Medicare pilot is limited geographically, many providers are already seeing similar requirements appear elsewhere — particularly in:

Medicare Advantage plans
Commercial insurance products
Employer-sponsored plans

Why?

Because payors talk to each other, watch CMS closely, and often adopt utilization management strategies before they become universal policy. If CMS is testing prior authorization in traditional Medicare, private insurers are unlikely to sit on the sidelines.

Think of it as a policy “soft launch.” 🚀

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Medicare Advantage & Commercial Plans: Already Old Pros at Prior Auth

Medicare Advantage plans have relied heavily on prior authorization for years. Commercial carriers, likewise, have long required authorization for everything from imaging to injections to durable medical equipment.

Recently, insurers have acknowledged what providers already know:

Prior authorization
Delays care
Increases administrative burden
Contributes to staff burnout

As a result, many carriers have publicly committed to modernization efforts, including:

Expanded electronic prior authorization
Faster turnaround times
Fewer services requiring approval
Clearer clinical criteria

That’s the good news.

The less good news? Implementation varies widely by carrier, plan type, and region. 🧩

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What We’re Seeing from Carriers (In the Real World)

While policies differ, common themes are emerging:

Requirements may apply even outside CMS pilot states
Some plans require authorization “just in case”
Product-specific rules matter (HMO ≠ PPO ≠ MA ≠ Commercial)
Older policies sometimes linger long after updates are announced

Translation: Assumptions are risky. Verification is essential. ✔️

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Practical Guidance for Providers & Practice Managers

Here’s what we recommend in this evolving environment:

1. Don’t assume Medicare = no prior auth anymore
Always confirm — especially for high-cost or frequently reviewed services.

2. Check the plan, not just the carrier
Requirements often differ by product line.

3. Use payer portals and electronic tools whenever possible
They’re not perfect, but they’re usually faster than faxing into the void. 📠➡️🕳️

4. Document medical necessity clearly and early
Clear notes save time on the back end.

5. Talk directly with payor representatives
When requirements are unclear, ask:

Does this service require prior authorization?
What documentation is required?
What are turnaround times?
Are there any upcoming policy changes?

Getting confirmation before the service can prevent denials, rework, and uncomfortable patient conversations later.

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The Bottom Line 🧭

Prior authorization is no longer just a Medicare Advantage or commercial insurance issue. It’s becoming a system-wide utilization management strategy, and providers should expect continued expansion — even beyond formal pilot programs.

The practices that navigate this best will be those that:

Stay informed
Build strong payor relationships
Invest in efficient front-end processes
And verify, verify, verify 🧐

At KLA Healthcare, we help practices stay compliant, reduce administrative friction, and adapt confidently as the reimbursement landscape continues to shift.

01/07/2026

A little glimpse of our LinkedIn leadership series. Hope you enjoy.

The Mississippi River does not try to do everything. It carries commerce, history, memory, and momentum across half a continent — steady, enduring, unapologetic.

01/05/2026

Top 10 Billing Truths Every Private Practice Physician Should Know for 2026

Billing in 2026 is less about “learning new tricks” and more about knowing which rulebook applies. Here are the top ten things medical providers should keep on their radar for 2026.

1️⃣ What is APM status — and can you change it?
Advanced Alternative Payment Models (APMs) are CMS-approved models that reward physicians for quality and cost efficiency rather than volume alone.
Examples include certain MSSP tracks, bundled payment models, and specialty-specific CMS Innovation models. Not all are available in each state. See https://qpp.cms.gov/eligibility-participation/apm/overview for more detail.

Why this matters in 2026:
• CMS now uses different conversion factors depending on whether you qualify as an Advanced APM participant
• APM participation can affect payment rates, reporting requirements, and incentives

How to change or pursue APM status:
• Most physicians cannot unilaterally elect APM status
• Status depends on participation in a qualifying CMS model and meeting payment or patient thresholds

Actions physicians can take:
• Join or form a qualifying ACO
• Evaluate CMS Innovation Center models relevant to your specialty. (See above.)
• Coordinate with billing, compliance, and leadership teams before the performance year begins

Translation: this is a strategic business decision, not a coding tweak. Generally, PCPs can be in only one. Specialists can participate in multiple.

2️⃣ Medicare is adding “efficiency adjustments.”
CMS finalized efficiency adjustments for certain non–time-based services. While E/M, care management, behavioral health, and many telehealth services are excluded, procedural-heavy practices should monitor how this affects margins.

Tip: Service mix matters more than ever.

3️⃣ Telehealth coverage is still evolving
CMS is simplifying how services qualify for the Medicare Telehealth Services List, focusing on whether the service can be safely delivered via interactive audio-video.
What to watch:
• Which services remain covered
• Documentation expectations
• Whether a service is permanent, conditional, or time-limited

Do not assume “it was covered last year” equals “it’s covered in 2026.”

4️⃣ Same-day preventive + problem visits require precision
Some payors are tightening rules around billing an E/M visit on the same day as a preventive service.

Key reminders:
• Modifier 25 must be fully supported by documentation
• Preventive codes ≠ problem-oriented E/M
• The medical record must clearly show separate and significant work

This is one of the most common denial triggers in private practice. Unfortunately, many billers believe that these services cannot be billed on the same day. Although there are limitations, most payors want patients treated. Beware though: because many items in wellness exams are included in E/M, levels 4 or 5 are routinely denied even with modification. You can't count elements twice on the same day.

5️⃣ “Started but not completed” procedures need correct modifiers
For reduced or discontinued procedures, Some payors apply different reimbursement percentages depending on the modifier used (52, 53, 73, 74).
Billing lesson:

The modifier choice must match the clinical scenario, or payment reductions (or denials) follow.

6️⃣ Dual-eligible billing workflows are changing
Some Medicare-Medicaid members are moving into more integrated plans, meaning:
• Claims routing may change
• Medicare and Medicaid services may be billed to a single plan

Front-office and billing staff must update payer routing or risk avoidable rejections. In Tennessee, TennCare is almost never the secondary payor!

7️⃣ TennCare programs have their own billing rules
If you participate in TennCare programs such as Tennessee Health Link, billing rules are governed by program-specific manuals — not just standard CMS guidance.

📘 Tennessee Health Link Provider Operating Manual
https://www.tn.gov/tenncare/providers/health-link.html

If you participate, this manual is required reading, not optional.

8️⃣ CMS Annual Wellness Visit vs ACA Preventive Services (they are NOT the same)
This is a frequent source of confusion. Talk with your customer service representatives to understand the rules of your major payors.

CMS Annual Wellness Visit (AWV):
• Medicare-only benefit
• Focuses on risk assessment, prevention planning, and cognitive screening
• No physical exam
• Codes:
• G0438 (initial AWV)
• G0439 (subsequent AWV)
Example billing:
Medicare patient receives an AWV with health risk assessment and prevention plan → bill G0439

ACA Preventive Services:
• Required under the Affordable Care Act
• Applies mainly to commercial plans
• Includes physical exam elements, age-based screenings, and counseling
• Codes:
• 99381–99387 (new patient)
• 99391–99397 (established patient)

Example billing:
Commercially insured patient receives annual physical with preventive screenings → bill 99396
Mixing these up almost guarantees a denial.

9️⃣ Balance billing rules still apply (even when it feels logical)
Federal and payer-specific balance billing protections apply in many situations. Private practices need:
• Clear financial policies
• Consistent staff scripting
• Documentation when services are non-covered
Surprises lead to complaints — not collections.

REMEMBER THE VALUE OF EACH PATIENT TO YOUR PRACTICE. Follow the rules but remember the patient is more important than the immediate dollar. THE PATIENT IS YOUR REASON FOR BEING!

🔟 Clean claims still win
In 2026, the highest-ROI improvements are still the basics:
• Accurate eligibility
• Correct payer routing
• Clean modifiers
• Strong documentation
• Electronic workflows for authorizations and claim status
Boring? Yes. Profitable? Also yes.

Bottom line:
Billing success in 2026 isn’t about working harder — it’s about working smarter, earlier, and with the right rules in mind.

12/05/2025

12/04/2025

Year-End Tax Planning for Private Practices: Because January Comes With Its Own Plot Twists

As the year winds down, private medical practices face a familiar financial whiplash: December finally brings fully met deductibles and stronger reimbursements… and then January arrives like a surprise plot twist nobody asked for.

Here’s how to plan now so your practice enters the new year prepared—not panicked.

1. Know Your Income. (And Remember: Income ≠ Cash Flow.)

Your bank balance may be loud, but it isn’t always truthful.

A few grounding reminders:
• Loan payments do not reduce taxable income—only the interest portion does.
• Buying equipment? The IRS prefers to depreciate it slowly over multiple years… like watching paint dry.
• The good news: Section 179 and bonus depreciation may allow you to write off equipment much more quickly.

2. Consider Prepaying Expenses Before December 31

Cash-basis practices may benefit from prepaying:
• Rent
• Malpractice insurance
• Business insurance
• Expected supply orders
A timely prepayment today may be a tax deduction this year—again, within reason. The IRS does NOT allow a cash basis tax payer to prepay for more than a year.

If you are considering a new piece of equipment, if it qualifies, financing the purchase now can reap big tax benefits. These purchases are tricky so check with your tax preparer

3. Prepare for the January “Double Reset”

December often brings stronger cash flow because most patient deductibles have finally been satisfied.

Then there’s January? January hits with two resets at once:

Reset #1: Most Deductibles Start Over
Patients now owe full deductibles again. That means:
• Slower collections
• More front-desk explanations
• A cash-flow dip just as you are recovering from the holidays

Reset #2: Employer Taxes Restart
In January, you begin paying:
• SUTA
• FUTA
• Social Security up to the wage base again

Which means:
Less income + higher expenses = a tougher first quarter.

Plan now so your financial oxygen tank is full before the January dive.

4. Review Retirement Contributions

One of the strongest year-end levers for medical practices:
• Solo 401(k)
• Safe Harbor 401(k)
• Profit-sharing contributions
• Cash-balance plans
These not only reduce taxable income but also support your long-term financial resilience.

5. Evaluate Accounts Receivable

Now is the time for a reality check.
If certain balances look permanently allergic to being paid, consider writing them off and discharging those patients who are chronic non payers

A cleaner AR ledger = more accurate financials and fewer headaches. Cash basis tax payers, this isn’t a reduction in income! But it does cut down on billing expenses The average bill costs $1.50 in postage, paper and staff time. Removing 1000 small balance, delinquent patient balances from your books equals $1,500 more in revenue per month.

6. Purchase Needed Supplies or Equipment

If you are cash-basis, buying necessary supplies before year-end may reduce your tax bill.
Keyword: necessary.
An entire truckload of exam gloves may raise questions—both from the IRS and your staff.

7. Review Owner W-2s and Distributions

Before December 31:
• Confirm owner compensation is “reasonable” (the IRS’ favorite vague word) Yes, you can pay your spouse and other family members for services rendered to your business, but keep all compensation comparable with others rendering the same services
• Review year-to-date distributions
• Adjust final payrolls if needed

8. Don’t Skip Compliance Wrap-Up

Year-end housekeeping leads to cleaner tax filings:
• Collect W-9s
• Verify which vendors require 1099s
• Reconcile bank accounts
• Double-check depreciation schedules
• Confirm loan balances

⸻

Final Thought

The transition from December into January can feel like going from a smooth clinical day to suddenly being triple-booked. With the deductible reset, slowing cash flow; with tax resets and increasing expenses. Solid planning in December gives your practice the stability it needs to enter the new year with confidence.

KLA Healthcare is here to help you plan, project, and prepare—so your practice stays financially healthy all year long.

11/25/2025

🍂 Thanksgiving 2025: Gratitude for Progress in Healthcare 🍂

As we approach Thanksgiving, all of us at KLA Healthcare pause to reflect and give thanks for the progress across the medical community this year.

2025 has brought challenges — but also remarkable breakthroughs that continue to strengthen the work of every practice, every clinician, and every front-office team.

Here are a few innovations we’re especially grateful for:

🔹 The Rise of Accessible AI in Everyday Practice

This year, AI became even more practical for front-office and clinical based operations. We’re grateful for tools that now help:

--Interpret complex lab data and imaging
--Support early detection of chronic diseases
--Streamline documentation
--Improve prior authorizations, eligibility checks, and claims accuracy
--Reduce administrative load so providers can focus more on what matters most: meaningful patient care!

AI isn’t replacing the human side of medicine — it’s strengthening it.

🔹 Major Steps Forward in Alzheimer’s Detection

2025 has been an extraordinary year for cognitive-health innovation.

We are thankful for:

--The first FDA-cleared blood-based biomarker test (Roche’s pTau181), giving primary-care physicians a powerful, non-invasive tool to help rule out Alzheimer’s-related amyloid pathology.
--New clinical guidelines encouraging the use of blood biomarkers to triage patients earlier and more accurately.
--CMS’s continued push for earlier diagnosis of cognitive decline, emphasizing timely documentation, screening, and referral pathways.

These developments empower front-office teams to coordinate earlier care, manage referrals more effectively, and support families who are navigating life-changing decisions.

🔹 Advancements in Wound Care & Skin-Substitute Oversight

We’re also grateful for progress in wound-care innovation such as

--Rapid growth in skin-substitute technologies for chronic wounds such as diabetic foot ulcers and venous leg ulcers.
--Emerging tele-wound monitoring tools using patient-submitted photos and AI-guided segmentation to help providers track healing more accurately.

🔹 A Healthcare Workforce That Keeps Showing Up

Most of all, we are grateful for the people who make patient care possible:
--Providers who continue learning, adapting, and caring.
--Front-office and billing teams who manage the vital backbone of every practice. Even the best provider cannot do his job without staff support,
--Administrators, coders, compliance leaders, and support staff who bring order to complexity.

Your dedication inspires us daily.

From all of us at KLA Healthcare — thank you.

We appreciate your partnership, your resilience, and your commitment to helping healthcare evolve with integrity and heart.

Wishing you and your families a warm, hope-filled Thanksgiving season. 🍁

10/31/2025

🌕 Tonight we remember: behind every costume is a story, and behind every story — a soul. ✨

10/28/2025

🚀 AI Meets Healthcare: CMS Introduces “Sage”
The Centers for Medicare & Medicaid Services (CMS) has launched a new artificial-intelligence system — Sage, an emotionally intelligent AI Care Manager developed by Ellipsis Health.

Sage can assist with eligibility checks, benefit verification, program outreach, care coordination, and even follow-up surveys — all while maintaining HIPAA and SOC2 Type 2 compliance.

For healthcare professionals, Sage represents an important shift: AI tools are beginning to ease administrative burden, enhance patient engagement, and free human teams to focus on meaningful care.

You can learn more about the CMS “Health Tech Ecosystem” and the Sage AI Care Manager at this link 👇
👉 https://www.cms.gov/health-tech-ecosystem/early-adopters/conversational-ai-assistants

🩺 Sources you can explore for more background:
• CMS Health Tech Ecosystem: https://www.cms.gov/health-tech-ecosystem/early-adopters/conversational-ai-assistants
• Ellipsis Health (Sage AI Care Manager): https://www.ellipsishealth.com/
• Press release: https://www.prnewswire.com/news-releases/ellipsis-health-selected-as-key-partner-in-cms-health-tech-ecosystem-to-drive-national-healthcare-ai-transformation-302518878.html

10/22/2025

🌟 2026 Quality Measures: What’s Changing & Who’s Ready 🌟

CMS’s 2026 Quality Payment Program (QPP) proposed rule may not yet be finalized—thank you, government shutdown—but it’s already shaping how we’ll measure and reward “quality” across healthcare.

📘 CMS summary (official overview):
https://mdinteractive.com/mips-blog/whats-new-2026-qpp-proposed-rule-key-updates-mips-and-aco-participants
Here’s the short version of what’s ahead ⬇️
✅ MIPS stays at 75 points – no major scoring shakeup, but smarter reporting and measure validation will matter more than ever.
✅ New Improvement Activities (IAs) emphasize AI safety, cognitive impairment screening, and oral health integration.
✅ Interoperability expands with new requirements for security risk management and data exchange via TEFCA.
✅ ACO changes aim for more flexible attribution and equity in value-based care participation.

👉 Translation: 2026 will reward practices that are data-ready, prevention-minded, and connected across care teams.

🏥 Medicare Advantage Plans: How They’re Adapting for 2026
(alphabetically listed for easy reference)
Aetna
Aetna reports that 81% of members are now in 4★ or higher plans, emphasizing continuity of care and medication adherence. Expect enhanced alignment with CMS Star measures in 2026.
🔗 https://news.aetna.com/2026-medicare-advantage-star-ratings/

Anthem / Blue Cross Blue Shield (Elevance Health)
Rolling out state-specific 2026 provider manuals and CAHPS/HEDIS weighting updates that mirror CMS’s equity-driven quality model.
📋 Copy/paste to learn more: https://www.elevancehealth.com/providers

Cigna Healthcare
Their updated Cigna Care Designation (CCD) criteria now reward only the top 34% of groups for both quality and cost efficiency. Practices below that cut-off may lose their CCD status.
📘 https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalPlansAndProducts.html
(See also: https://cignaforhcp.cigna.com/app/login)

Humana
Focus areas: medication adherence, preventive screenings, and a tighter feedback loop for Stars scoring in 2026. Humana continues to pair quality incentives with wellness engagement.
📎 Copy/paste: https://press.humana.com/news/news-details/2026-star-ratings/

UnitedHealthcare
2026 MA Quick Reference Guide highlights the push toward quality-first network design and CMS Stars alignment. Expect closer data reviews for chronic condition management.
📄 Copy/paste: https://www.uhcprovider.com/

🧭 What You Can Do Now
1️⃣ Review your 2023–2024 performance data (these years set the stage for 2026) WITH YOUR insurance company’s Provider Relations Representative. Schedule this now.
2️⃣ Audit your quality and interoperability documentation now—CMS expects a clean chain of evidence.
3️⃣ Stay alert for final rule updates once the government reopens—CMS will move quickly.