Glenda Hull, BSN

In this INOvators episode, Kate Eshelman shares how risk adjustment processes may shift this year & what health plans need to do to prepare.

It’s no longer a question of if, but when. In May 2025, the Centers for Medicare & Medicaid Services (CMS) announced a more aggressive strategy for conducting Medicare Advantage Risk Adjustment Data Validation (RADV) audits.

In value-based care, shared goals between health plans and providers are only possible when both parties are working from the same playbook. But in reality, providers are often left to guess at the full picture. Many don’t have access to their patient’s complete medical history, especially those not using large EHR systems. That lack of visibility can mean missed care gaps, delayed diagnoses, and extra administrative burden for both the provider and the health plan. 

Explore the transformative effects of AI in MRR, and what this may mean for health plan reporting and member care in 2025.

Hear from Dr. Kathryn Eshelman on why AI and clinical expertise in healthcare must work together, not in place of each other.

Every year, the Centers for Medicare and Medicaid Services (CMS) conducts Medicare Advantage Risk Adjustment Data Validation (RADV) audits on Medicare Advantage (MA) plans to validate the accuracy and completeness of their data used in risk adjustment.