Jun. 9 at 4:05 PM
$CLOV
It’s finally coming.
Many investors are looking at Clover Health’s recent CMS lawsuit victory as a one-time legal win. The bigger story may be what it signals about where Medicare Advantage is headed over the next decade.
For years, the Medicare Advantage industry evolved around optimizing for a complex set of Star Rating measures, administrative processes, and compliance requirements.
The companies that became giants,
$UNH,
$HUM,
$CVS, and
$ELV, built enormous organizations around these rules.
The problem?
CMS is increasingly moving toward rewarding actual health outcomes rather than process-oriented metrics.
That trend is accelerating….
