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I am a data-driven Product R&D Director with over ten years of progressive experience…
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Peter Yates
Medicare Advantage Star Measures Are Raising the Bar I’ve been refreshing my analytics code ahead of the October MA Star data release. With help from OpenAI Codex, I completed some trending and cut-point visualizations I’ve had in mind for years. The results are striking: plan quality distributions keep shifting upward—yet achieving 4–5 Stars is tougher than ever. Consider the Statin Use in Persons with Diabetes (SUPD) measure for MA-PD plans: - SY2021 – an 85% score earned 4 Stars - SY2025 – that same 85% now earns 2 Stars My accompanying chart tells the story: higher overall industry performance, but a much steeper climb for top ratings. Let me know if there are any particular measures of interest. If you try this at home, keep in mind that CMS can and does change the Measure ID year to year so you have to build a mapping table to do trending.
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Inna Sheyn
𝗔𝗖𝗔 𝗠𝗮𝗿𝗸𝗲𝘁 𝗙𝗮𝗰𝗲𝘀 𝗥𝗶𝘀𝗶𝗻𝗴 𝗙𝗿𝗮𝘂𝗱 𝗦𝗰𝗿𝘂𝘁𝗶𝗻𝘆 𝗮𝗻𝗱 𝗥𝗮𝘁𝗲 𝗦𝗵𝗼𝗰𝗸 New CMS data indicate a surge in broker fraud in ACA exchanges, with the share of enrollees showing no claims rising from 23% in 2019 to 35% in 2024, particularly in non-expansion states like Florida and Texas. Program integrity efforts and the potential loss of enhanced subsidies are expected to push healthier, subsidized members out of the market, potentially raising premiums and squeezing margins. Centene, with broad exposure, is already requesting rate hikes above 50%, while the median increase across insurers is 18%. State regulators, insurers, and policymakers now face mounting tension between fraud crackdowns and affordability.
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Milliman IntelliScript
One of America’s largest life insurers changed up its underwriting playbook by ordering Irix Medical Data and Prescription Data from the get-go. Some product teams were nostalgic for their old, familiar workflows, but only until they realized the change cut turn times in half—and APS orders by 90%. What are you waiting for? (Besides that APS you requested three weeks ago?) Here are the proof points you need to spark change at your organization and actionable advice you can use to put disruptive insurtech to work, *without* disrupting your own operations. https://lnkd.in/g9njRJGG
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