Venture Resource Blog

Angela Lawrence, Business Development Manager at Venture Solutions, has been on the move recently, attending three major healthcare conferences, including the Medicaid Enterprise Systems Conference (MESC), IT Solutions Management, and American Public Human Services Association (ISM-APHSA), and California Association of Health Plans (CAHP).  While each conference focused on different aspects, it was clear that regulatory shifts, rising costs, and an urgent need for innovation are challenging the industry.

Angela’s assessment of these events revealed a consistent theme: that eligibility accuracy and regulatory compliance are top priorities.  Whether discussing Medicaid, Medicare, or commercial plans, stakeholders are focused on navigating the complexities of HR 1, the federal budget reconciliation bill reshaping healthcare operations nationwide.

Faced with shifting health plan policies, rising costs, and a growing demand for vendor collaboration, industry leaders are focusing on practical solutions that provide stability, operational efficiency, and reliable support.

• AI in Healthcare: AI is revolutionizing claims processing, underwriting, and eligibility verification. Trust, transparency, and privacy remain major concerns, but their potential is undeniable.
• Compliance: The federal HR 1 bill introduces sweeping changes across Medicaid, Medicare, and commercial markets. From provider tax reforms to new eligibility verification rules, plans are adapting quickly.
• Cost Pressures: With rising drug prices and shifting funding models, health plans are exploring telemedicine, preventive care, and flexible benefits to serve members and manage costs.
• Medicare Advantage Momentum: As the population ages, Medicare Advantage is expanding rapidly. Plans are refining networks and benefits to stay competitive and compliant.
• Vendor Collaboration: States are calling for vendors to collaborate and create scalable, cost-effective solutions that benefit multiple markets.

• Accuracy is Everything: Inaccurate eligibility approvals can result in penalties. Plans are seeking tools that ensure precision and compliance.
• Communication is Critical: From cadence-based mailings to multilingual outreach, getting the right message to the right member is essential.
• Change Challenges: While AI is promising, most plans are focused on managing change, not launching new initiatives.
• Funding Flux: With enhanced premium tax credits set to expire, health plans require support to adapt to regulatory and funding changes.

Angela highlighted America’s Health Insurance Plans (AHIP) leadership in helping health plans navigate HR 1.  The association’s advocacy and resources are assisting insurers to adapt to new Centers for Medicare & Medicaid Services (CMS) rules, including changes to provider taxes, state-directed payments, and eligibility redeterminations.

The healthcare industry is facing more regulation, tighter budgets, and a growing need for responsive, compliant partners who understand the stakes.

Join Venture Solutions in simplifying healthcare operations, enhancing member engagement, supporting compliance, and delivering innovative solutions that meet today’s challenges.

Angela will attend the Texas Covered Healthcare Conference & Expo (November 3-5, 2025) and The RISE Medicare Marketing & Sales Summit (February 25-27, 2026).  Connect with her at an upcoming event or reach out directly at Angela.Lawrence@venturesolutions.com.