Upward Growth Substack

Q3 Earnings Showed Where Health Plans Expect Their 2027 Margin to Come From

Exits and repricing restored profits in 2026. Next year leans on operations, integrated payer models, MA scale, Medicaid acuity, and a consolidating ACA…

Nov 10 • Ryan Peterson

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MA Is Shrinking Nearly Everywhere. The One Place It Is Growing Is Getting Harder to Ignore.

Where C-SNP growth, V28 economics, and regulatory attention converge into the 2028 bid cycle.

Nov 3 • Ryan Peterson

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October 2026

The 2026 ACA Shakeout Six Months In: Which Health Plans Read the Risk Pool Correctly

Open Enrollment Period (OEP) opens November 1 and tests which plans priced 2027 for the acuity trajectory that actually arrived, and which priced for a…

Oct 27 • Ryan Peterson

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What Nebraska’s Six Months of Medicaid Work Requirements Suggest About the January 1 National Rollout

A closer read of Nebraska’s data, what state execution means for the January 1 national rollout, and what this does to 2027 capitation rates set before…

Oct 20 • Ryan Peterson

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The 2027 Star Ratings Separated Margin Work From Stars Work Across the Five Nationals

A read on the gap between stated Stars strategy and operational reality across the five Nationals, with the Q3 earnings calls ahead.

Oct 13 • Ryan Peterson

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What the 2027 MA Landscape File Reveals About Insurer Operating Discipline

Insurers took different operating paths to close the same 2027 rate gap. The peer-comparison lens is what sharpens Q4 and 2028 bid planning.

Oct 6 • Ryan Peterson

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September 2026

The Prior Auth Arms Race Is Defensive on Both Sides. That Is Why the Spend Compounds Instead of Resolving.

Providers are automating to defend margin. Plans are automating to defend compliance exposure. The spend keeps compounding because neither side can…

Sep 29 • Ryan Peterson

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Indiana Just Released the First Post-OBBBA State Medicaid RFP. Here Is Why It Matters.

Indiana's $68 billion reprocurement previews what the state Medicaid buyer becomes when federal contraction on plan operations meets state expansion.

Sep 22 • Ryan Peterson

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Medicare Advantage May Be Stabilizing, but Risk Adjustment Is Not.

What V28, chart review exclusion, and RADV expansion are doing to health plan operating models, and which plans are structurally positioned for CY 2028.

Sep 15 • Ryan Peterson

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Your MA, Medicaid, and ACA Q4 Just Got a New Source of Pressure. It's From Employers.

Employer commercial book decisions are landing on health plan finance now, and reshaping vendor, PBM, and provider decisions for CY 2027.

Sep 8 • Ryan Peterson

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Provider-Sponsored Plans Are Picking Which Lines of Business Integration Actually Pays For

Why integration pays PSPs in Medicare Advantage and costs them in Marketplace and Medicaid, and what that predicts next.

Sep 1 • Ryan Peterson

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August 2026

Health Plans Priced 2027 ACA Rates Against a Rule the Court Just Paused. Q2 Earnings Made the Bet Harder to Defend

What the paused NBPP rule, Q2 hospital and payor earnings, and a compressed Open Enrollment calendar mean for health plan 2027 ACA postures.

Aug 25 • Ryan Peterson

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