09 Sep Health Data News Roundup: Cracking 2025 CMS Start Ratings Code; Humana to Exit MA Markets; and Payers and Medical AI

Welcome to the Health Data Weekly News Roundup from IMAT Solutions. As the power of data continues to grow in the healthcare arena, today’s care organizations need to be on the forefront of all news and trends to help ensure that their data analytics efforts deliver accountable and informed care. Each week, we will provide you with the actionable news you need to meet these goals.

Cracking the Code to 2025 CMS Star Ratings
MA Plans that actively innovate and continuously improve their operations tend to be the high achievers in terms of Star Ratings and other key performance metrics, according to this recent FTI Consulting analysis.

How Enhanced Premium Tax Credits Could Affect Health Equity
The American Rescue Plan Act’s enhanced premium tax credits for Affordable Care Act enrollees could bring greater health equity in coverage rates in 2025, but only if Congress extends these credits before they expire next year, according to the Urban Institute.

Humana to Exit 13 Medicare Advantage Markets
Humana will exit Medicare Advantage markets in 13 counties in 2025, and it will affect around 560,000 beneficiaries, approximately 10 percent of Humana’s MA membership, according to Becker’s Payer Issues.

How Payers Can Gain the Full Benefits of Medical AI
Health payers are increasingly dependent on clinical data for making business and coverage decisions. Though, many are unable to access and analyze unstructured clinical data from provider organizations, and Medical AI could be the solution.

Payer CareSource Offers Financing Help to Rural Georgia Hospitals
CareSource, a Georgia-based managed care plan, recently created a Rural Access Advancement Program (RAAP) to assist rural hospitals and hospital-owned skilled nursing home facilities in rural Georgia address cash deficits that might otherwise lead to service limitations or hospital closures.

The Lesson Medicare Advantage Plans Can Learn from the ’90s
The challenges Medicare Advantage insurers are facing now aren’t without precedent, according to a recent analysis and comparison to the late 1990s Medicare+Choice — the precursor to Medicare Advantage that faced rising medical costs and lowered reimbursements.

AHIP: The Future of Healthcare Privacy — What Payers Need to Know
AHIP is hosting a webinar that is designed to equip healthcare payers with the knowledge and strategies needed to navigate the increasingly complex landscape of healthcare privacy regulations.