Health Care Matters | August 7
Medicare Advantage Star Ratings Lawsuits Add Pressure for Broader Reform
A growing number of Medicare Advantage insurers are challenging how the Centers for Medicare & Medicaid Services (CMS) calculates star ratings, which determine eligibility for billions of dollars in quality bonus payments. A federal court recently found that CMS improperly included 20 measures in Clover Health’s 2026 rating and ordered the agency to recalculate it, increasing the contract’s rating from 3.5 to 4.5 stars. CMS has appealed the decision, while Elevance Health, SCAN Health Plan, and Alignment Healthcare have filed additional lawsuits arguing that the agency did not apply the revised methodology consistently across plans. Read here.
Why It Matters
The litigation highlights how heavily Medicare Advantage payments can depend on small methodological and procedural differences within a complex quality measurement system. Recalculating ratings for individual plans may resolve specific disputes, but inconsistent treatment across contracts could create further volatility in bonus payments, plan bids, and benefit decisions. The cases also raise a broader question about whether star ratings are functioning effectively as both a measure of quality for beneficiaries and a payment mechanism for plans. With CMS already reconsidering parts of the program, the legal challenges may increase pressure for a more transparent and stable approach that places greater weight on meaningful clinical outcomes and beneficiary experience.
Look for the Helpers: Hawaii Takes Aim at Medical Debt and Gaps in Preventive Care
Hawaii has enacted three measures designed to make care more accessible and reduce the financial strain that can follow a serious diagnosis. The new laws expand coverage for fertility preservation and colorectal cancer screening while creating a program that could erase up to $91 million in medical debt for as many as 50,000 residents. Together, they reflect an effort to address not only access to care, but also the lasting financial consequences that can keep people from seeking treatment or rebuilding stability afterward. Read here.
What We're Attending
Reducing Quality Reporting Burden with FHIR
August 19, 2026 | 1:00 p.m. ET
ICF will host CMS and interoperability experts for a discussion of how Fast Healthcare Interoperability Resources (FHIR) can support more automated, standardized, and timely quality measure reporting. The session will cover FHIR application programming interfaces, bulk data access, computable measure logic, and practical considerations for implementation and alignment with CMS priorities. Register here.
What We Are Reading
hare of Physicians With J-1 Visas Training in the US Increased Steadily, 2016–24
A Health Affairs study examines the growing reliance on physicians training under J-1 visas, particularly in regions and specialties already experiencing workforce shortages. Read here.
Anchoring Health Financing on Better Outcomes
A National Academy of Medicine discussion paper identifies opportunities to better align health financing with prevention, coordination, affordability, and improved outcomes. Read here.
How Has ACA Marketplace Enrollment Changed Across States in 2026?
A KFF analysis explores how Marketplace enrollment changed following the expiration of enhanced premium tax credits, including differences linked to state subsidies and enrollment platforms. Read here.
A Physician’s Guide to Effective Revenue Cycle Management for Value-Based Care
An American Medical Association guide offers strategies for integrating fee-for-service and value-based revenue cycle operations while reducing administrative burden and improving financial performance. Read here.
Pop Health Podcast
Turning Denial Appeals Into a Faster Workflow
In this episode of Bright Spots, Coral’s Kate Freeman speaks with Gretchen Heinen, Founder and CEO of Authsnap, about how AI-enabled tools can help reduce the administrative burden of insurance-denial appeals and medical-necessity documentation. The conversation explores how Authsnap supports clinics, hospitals, and health care organizations by streamlining work that has traditionally required hours of manual review, helping providers manage growing volumes of commercial-payer and specialty-drug denials with greater speed and accuracy. Gretchen shares how her experience as a utilization-management nurse shaped the development of Authsnap, what implementation looks like in real-world provider workflows, and what tools like Authsnap could mean for the future of prior authorization, revenue cycle operations, and patient access to care.