Medicare Advantage Risk Adjustment & Quality
Powering Smarter Risk, Quality, and Value-Based Care
As Medicare Advantage (MA) grows—now covering more than 33 million beneficiaries in 2024 (CMS)—payers and providers face increasing pressure to close coding and care gaps, improve quality scores, and protect revenue in risk-sharing arrangements.
That’s where Health Data Max delivers.
Why HDM for Medicare Advantage?
🔹 End-to-End Risk Adjustment
Capture and validate chronic condition diagnoses with AI-driven chart review.
Support CMS-HCC compliance, RADV readiness, and encounter submissions.
Ensure accurate RAF scoring and prevent revenue leakage.
🔹 HEDIS & Quality Performance
Track Star Ratings and HEDIS metrics in real time.
Identify care gaps across preventive screenings, chronic conditions, and follow-up measures.
Equip providers with actionable insights to improve outcomes and performance bonuses.
🔹 Advanced Analytics + NLP
Combine structured claims with unstructured clinical data (notes, discharge summaries, labs).
Use Natural Language Processing (NLP) to surface missed diagnoses and coding opportunities.
Gain a 360° view of each member’s health status.
🔹 Proactive High-Risk Patient Management
Flag rising-risk and high-utilization members early.
Optimize care management programs to reduce avoidable admissions.
Improve population health while meeting CMS quality thresholds.
The HDM Advantage
Accuracy + Compliance → Ensure CMS submissions are clean, timely, and audit-ready.
Better Care, Better Scores → Improve HEDIS/Stars performance with AI-backed insights.
Revenue Protection → Capture every valid HCC to optimize risk scores.
Transparency → Dashboards give payers full visibility into provider and program performance.
In today’s Medicare Advantage market, precision wins.
With HDM, you get a partner that blends advanced analytics, NLP, and CMS-compliant workflows—helping your plan thrive in value-based care.
It’s your data. Let’s make it work harder.
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