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Hear from thought leaders across the healthcare spectrum or earn CME credits on risk adjustment coding and value-based care courses.

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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

Watch our webinar on hypertensive chronic kidney disease

Education hub

Lunch-and-learn: Hypertensive chronic kidney disease

Watch our webinar to learn more about ICD-10-CM coding guidelines for hypertensive kidney disease and how to accurately code the condition for risk adjustment.

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Provider

Risk adjustment

Education hub

Lunch-and-learn: COPD

Watch our webinar to learn more about ICD-10-CM coding guidelines for COPD and how to accurately code the condition for risk adjustment.

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Provider

Risk adjustment

Education hub

Lunch-and-learn: Cardiac arrhythmias

Watch our webinar to learn more about ICD-10-CM coding guidelines for cardiac arrhythmias and how to accurately code the condition for risk adjustment.

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Provider

Risk adjustment

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

Education hub

Lunch-and-learn: Diabetes

Watch our webinar to learn more about ICD-10-CM coding guidelines for diabetes and how to accurately code the condition for risk adjustment.

Watch now

Provider

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

Education hub

Increased regulatory scrutiny calls for accuracy and PCP involvement in risk adjustment programs

Over the past several years, there has been a noticeable uptick of claims against Medicare Advantage Organizations (MAOs) centering around what the government alleges are aggressive initiatives focused on boosting risk scores and associated payments.

Risk adjustment

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