BLOG

Risk-bearing entities such as IPAs, MSOs, and health plans — especially those operating in the Medicare Advantage space — are facing unprecedented challenges. The implementation of CMS’s Hierarchical Condition Category (HCC) risk adjustment model Version 28 (V28) is already reshaping the industry. With regulatory changes that reduce risk scores and, consequently, reimbursements, Medicare Advantage Organizations (MAOs) must rethink their risk adjustment strategies….

Life has a way of presenting us with stories that leave an indelible mark on our hearts. Recently, I had a conversation with a long-lost friend that opened my eyes to the harsh realities of our healthcare system. This encounter led me on a journey of exploration, seeking to understand the intricacies of prior authorization,…

Chronic disease is not a new problem in Medicare — but it is a problem that is persistent, expensive, and stubbornly resistant to the payment structures designed around it. More than two-thirds of Medicare beneficiaries live with at least one chronic condition. Many carry several, layered and compounding: hypertension alongside diabetes, chronic kidney disease accelerating…

When the Centers for Medicare & Medicaid Services(CMS) released its January 26 Medicare Advantage Proposed Rule 2027, most attention went straight to the rates. That reaction was predictable. Payment updates influence bids, margins, and near-term strategy across organizations participating in Medicare Advantage. Medicare Advantage Proposed Rule 2027: The Headline Number Isn’t the Whole Story Beneath the…

Each year, Medicare Advantage organizations recalibrate when the latest guidance arrives from the Centers for Medicare & Medicaid Services (CMS). In early spring, the Medicare Advantage CMS Advance Notice 2027 (the CMS Advance Notice) outlines proposed payment updates for the upcoming plan year — including adjustments to risk models, normalization factors, benchmarks, and Star Ratings methodology. Later in…

By Arun Hampapur, PhD – Co-Founder & CEO, Bloom Value; Fellow, IEEE Disclaimer: This article was originally published in Health IT Answers, “The UnitedHealth Probes: A Wake-Up Call for Medicare Advantage“, July 15, 2025. Introduction The U.S. healthcare industry is once again in the spotlight—this time, with the scrutiny on UnitedHealth. The Department of Justice (DOJ) has…

Introduction: Defensibility in the Spotlight Recent headlines involving UnitedHealth’s Medicare Advantage practices have brought one word to the forefront of risk adjustment practices in healthcare: defensibility. Risk adjustment practices can no longer focus solely on accuracy or completeness. It must also withstand external scrutiny, internal standards, and growing expectations around ethics and transparency. One major…

As part of our series “How To Effectively Leverage Data To Take Your Company To The Next Level”, I had the pleasure of interviewing Dr. Arun Hampapur. Founder and CEO of Bloom Value Corporation (a technology startup focused on applying enterprise AI for Healthcare Provider FinOps), Arun Hampapur has a Ph.D. in Artificial Intelligence from…