Terri Kline

Costs continued to rise while access and outcomes continue to stagnate. Fixing this entails a national plan, one that right sizes our outpatient primary care infrastructure, controls drug costs and renders profiteering illegal.

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CMS just dropped the CY 2027 Advance Notice for Medicare Advantage — proposing full V28 adoption with no transition, exclusion of unlinked chart reviews, and meaningful downward pressure on risk scores. These shifts accelerate the move to prospective, encounter-based documentation and tighter source integrity. At Secondwave, we’re helping MA plans build resilient, real-time CDI strategies to thrive in this environment. What are your thoughts on these proposals? Drop a comment or DM me to discuss implications for your organization. #MedicareAdvantage #RiskAdjustment #CMS #HealthcareCompliance”

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We need to be rowing in the same direction on value based across payer channels. Unfortunately, we are not. Important study on the lack of MSSP ACOs and MA spillovers into commercial utilizing Health Care Cost Institute claims data. https://lnkd.in/eQc22qwm

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Strong analysis on where Medicare Advantage is heading Ernie Ianace. What I would add is this: the shift toward D-SNPs and higher-acuity populations is less about expansion strategy and more about operating discipline. When payers narrow their footprint and lean into duals, they are signaling something very clear. Breadth without precision is expensive. Acuity with structure is manageable. From the provider side, this changes the playbook. Caring for dual eligible and chronic SNP populations requires more than enhanced benefits. It requires an operating engine built for complexity. That means integrated clinical workflows, behavioral health embedded in primary care, tight medication management, real time risk capture, and meaningful documentation of functional outcomes. Most organizations still treat care coordination as a department. In high acuity MA, it must be the architecture. For senior living operators and risk bearing provider groups, this is a defining moment. The winners will be those who can: • Reduce avoidable admissions through proactive longitudinal management • Demonstrate measurable impact on total cost of care • Align tightly with plans around shared accountability for outcomes • Operationalize data, not simply collect it The opportunity is significant. So is the execution gap. Medicare Advantage is evolving from scaled enrollment growth to precision population management. The organizations that can manage acuity with rigor and consistency will define the next phase of value creation in this space. Curious how others are thinking about D-SNP readiness given the 2026 shift.

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Star Ratings as a Strategic Imperative and Why Alignment Sets the Benchmark   Today, star ratings in Medicare Advantage show how well plans deliver quality, build trust, and stay sustainable. CMS reviews these ratings based on clinical results, member experience, complaint handling, retention, and access to care. Managing these areas takes focus and commitment.   This is why Alignment Health Plan’s latest results stand out. For the second year in a row, 100% of members are enrolled in plans rated 4 stars or higher. Two Nevada HMO contracts earned 5 stars, and a Texas plan earned 4.5 stars. These results demonstrate that a member-first care model can be replicated and scaled, rather than being a one-time achievement.   Why This Matters   1. Sustained reliability Many plans aim for high star ratings but struggle to maintain them as CMS raises the bar. Alignment’s California HMO has held 4 or more stars for nine years in a row, which is rare. This steady performance leads to better risk management, stronger member loyalty, and more reliable bonus incentives. 2. Clear market differentiation. Medicare’s Plan Finder clearly displays star ratings, which directly impact consumers' choices. High ratings give plans a real edge over competitors, not just a mark of honor. 3. Quality as a business driver, not just compliance.   The most successful plans prioritize quality by closing care gaps, retaining valuable services, and responding promptly to members, rather than merely meeting minimum requirements.   The New Age of Medicare Advantage   New carriers are transforming the industry through flexibility, data-driven insights, digital engagement, and a focus on members. Here’s what makes them different:   * Flexible modular care models delivering individualized quality care * Bold benefit innovation that differentiates * Relentless measurement and iteration, where analytics feed continuous quality improvement * Culture-driven execution, where clinical leaders, operations, and member services act with alignment   Alignment demonstrates how these strengths can be leveraged on a large scale to consistently deliver great results across different markets.   Our Dedication to Long-Term Quality   * We invest in quality to achieve lasting results that can be replicated across different markets, yielding clear benefits from the first year. * Our benefits are tied to clear clinical and satisfaction goals, as shown by our star ratings and member feedback. * All of our members are enrolled in high-rated plans, not just a select few.   The future of Medicare Advantage will favor those who pair strong performance with new ideas that put members first. Alignment is already leading the way and setting the standard for the next generation of plans.   #AlignmentHealthPlan #AlignmentHealth #Duals #HealthcareLeadership #AdvocacyMatters #ValueBasedCare #FreedomOfChoice #LeadershipInAction #MedicareAdvantage #HealthPolicy

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Medicaid cuts are reshaping healthcare finance. For safety net systems, the stakes couldn’t be higher. Here’s what I shared with Chief Healthcare Executive 👇 Too often, underserved patients feel ashamed to ask for financial help. Meanwhile, uncompensated care threatens provider sustainability. Our partner LCMC Health is preparing for this reality by rethinking how to engage patients early. Because when we reduce friction and proactively connect people to aid, we protect access to care and help providers get paid for their critical work. Personalized financial engagement isn’t just a nice-to-have—it’s essential for healthcare’s future. Read more, including perspective from LCMC Chief Revenue Officer Anthony Cunningham: https://lnkd.in/d5u_8etv

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$758K settlement. Virginia lab paid kickbacks disguised as "consulting fees" to push unnecessary tests on Medicare patients. 💉💰 NEXT Molecular Analytics allegedly paid doctors and marketers commissions based on test volume—then billed Medicare, Medicaid, TRICARE. DOJ: "Corrupts medical judgment and poisons the doctor-patient relationship." Whistleblowers getting $113,700. DOJ says this isn't a paper crime—it misleads patients and wastes taxpayer money. #HealthcareFraud #Kickbacks #Medicare #Medicaid #TRICARE #LabFraud #DOJ #MedicalFraud #HealthcareNews #FalseClaimsAct #Whistleblower #TaxpayerMoney #HealthcareCrime #MedicalTesting #FraudAlert #Accountability #HealthcareCorruption #Virginia #MedicalLab #PatientSafety

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