Blogs

Featured blog

Health plans and providers join forces to navigate turbulent market conditions

Multiple headwinds have created a challenging Medicare Advantage market for both health plans and providers. Presenters at the 2025 RISE National conference suggested a unique way to address the situation: shared resources among health plans and providers to maximize compliant risk adjustment performance.

All insights

Blog

Health plans and providers join forces to navigate turbulent market conditions

Multiple headwinds have created a challenging Medicare Advantage market for both health plans and providers. These headwinds include the transition to CMS-HCC V28 for risk adjustment, heightened regulatory scrutiny, increased audit activity, reimbursement pressure, shifting star ratings and evolving expectations under new CMS leadership. Presenters at the 2025 RISE National conference suggested a unique way to address the situation: shared resources among health plans and providers to maximize compliant risk adjustment performance.

Health plan

Provider

Risk adjustment

Blog

Technology in risk adjustment: opportunities and pitfalls

One area seeing a surge in AI-driven innovation is HCC coding and documentation. A growing number of tools now aim to automate risk adjustment coding, promising increased efficiency and reduced costs. While these solutions offer potential benefits, they also present serious challenges that health plans and providers must carefully evaluate.

Risk adjustment

Value-based care

Blog

What’s going on with Medicare Advantage and risk adjustment?

One of the biggest challenges facing MA plans concerns changes to risk adjustment regulations. These changes in turn affect providers. Risk adjustment is complex, and most providers are not well versed on this topic. Let’s break it down and explore how the right partnerships and resources can help providers succeed in the current turbulence that’s affecting the MA ecosystem.

Risk adjustment

Blog

Innovative paths to success in today’s MA market

Health plans participating in Medicare Advantage face multiple challenges: decreased revenue due to CMS-HCC V28, new Stars cut points and increased regulatory scrutiny, to name a few. Vatica Health shares experiences working with health plans and providers across the country on ways to maintain margin in this challenging environment.

Risk adjustment

Blog

Key metrics for value-based care

Value-based care (VBC) is designed to incentivize providers to improve outcomes in a cost-efficient manner. In other words, payment and quality of care are inextricably linked.

Value-based care

Blog

What’s behind the move from retrospective to prospective risk adjustment?

Health plans across the country are recognizing the superior value of prospective risk adjustment programs, and rightfully so.

Provider

Risk adjustment

Blog

Another blow to detached health risk assessments

Health Affairs recently published a study of data from 4 million Medicare Advantage (MA) members indicating that health risk assessments (HRAs) contributed up to $12 billion per year to risk adjusted payments in 2020.

Provider

Risk adjustment

Value-based care

Blog

Four observations from the frontlines regarding our recent VBC survey

Vatica Health recently conducted an independent survey of over 100 managers and executives of primary care practices and health systems to learn what’s working for them and what still needs to be addressed to facilitate a smooth transition to value-based care.

Value-based care

Blog

Relieve providers’ admin burden to help combat burnout

Provider burnout isn’t new. It existed long before COVID and was exacerbated by the pandemic. But it’s rising to new levels.

Provider

Risk adjustment

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