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November 12, 2026

Takeaways from the most recent news in the technology and policies shaping healthcare.

Payers

CMS Releases 2027 Medicare Advantage Star Ratings

CMS released its 2027 Medicare Advantage star ratings on Oct. 8, according to Becker's Hospital Review, offering a clearer picture of plan quality than insurers' own marketing materials.

Each MA contract receives an annual rating from one to five stars. The scores help beneficiaries compare plans during enrollment, but they carry far bigger financial stakes for insurers. Ratings determine quality bonus payments, which plans use to fund extra benefits and stay competitive. Four stars is the critical threshold: contracts that hit it qualify for bonus dollars, while those that fall short lose a major revenue stream.

The release matters because star ratings sit at the center of MA economics. Strong ratings let plans offer richer benefits and attract more members, creating a reinforcing advantage. Weak ratings squeeze margins and limit what insurers can put in front of seniors. For an industry already navigating tighter reimbursement and rising medical costs, the 2027 scores will shape benefit designs, marketing, and bottom lines heading into next year's enrollment cycle.

More in Payers

Payers

Hospitals Split on Owning Health Plans as Systems Exit

Several large health systems have sold or closed their insurance arms in the past two years, exposing a widening divide over whether providers should own health plans.

Why it matters: Whether a hospital owns an insurer shapes its revenue, risk, and leverage against payers, making it one of the defining strategic bets in healthcare.

Payers

Humana, Athenahealth Expand Electronic Prior Authorization

Humana and Athenahealth are scaling electronic prior authorization across 180,000-plus clinicians, with most September transactions requiring no manual staff work.

Why it matters: Prior authorization is a leading driver of provider burnout and administrative cost, and automation embedded in the EHR is how new federal mandates get put into practice.

Payers

How Health Plans Tell If Their Payment Ops Can Scale

Health plans can gauge whether their payment operations can truly scale by watching exception volume, return rates, and digital payment share as transaction counts rise.

Why it matters: Payment infrastructure that fails under growth drives up administrative costs and strains provider relationships just as a plan expands.