What’s Next for Risk Adjustment? The 2026 Landscape

CMS is increasing its volume of RADV audits and starting to apply AI in audits. Providers are leading the healthcare space in AI testing and adoption. Meanwhile, health plans are just starting to dip their toe in the water.

In this INOvators episode, Kate Eshelman, M.D., MPH, VP of Medical Informatics at Inovalon, predicts that 2026 will be the year for health plans to improve audit readiness and better address risk adjustable conditions with the help of AI. Hear how to thoughtfully scale your plan’s AI usage and learn how this technology – built right into an EHR – can help flag, address, and appropriately document risk adjustable conditions so the doctor in the room knows what to do, the patient receives the care they need, and fewer in-home assessments are needed to deliver optimal outcomes.