Managed Medicaid Sponsors

HealthyInsights helps MCOs shift from fragmented compliance to a Verification-Based Social Intelligence and Reimbursement strategy. Our patient-driven platform unifies clinical and social risk data, delivering the evidence plans need to justify rising post-unwinding acuity, operationalize the CMS Health Equity Framework, and exceed the expectations of our beneficiaries.

Managed Medicaid Value Proposition

± 2%

Predictable risk score variance compared to ±8% baseline with Verification-based Reimbursement and HealthyInsights Platform

40%

Reduction in audit-related risk exposure with RADV-ready evidence of beneficiary health profile, verified care delivery, and mitigated care gaps.

60%

Estimated reduction in audit reversals from gaps in coding and clinical execution using AuditIQ and the Assessment-to-Action (A2AI) Index.

3 Year Managed Medicaid Plan

Enhance Health & Equity Access

Improve Quality Care & Outcomes

Improve Operational
& Financial Performance

Adapt to Policy and Regulatory Changes

20%

Improvement in early identified cognitive impairment, frailty, and other high-cost drivers often missed by traditional health and risk assessment practices.

35%

Reduction in provider burden with automated Health Insights reporting that free up clinical time to close care gaps that drive star rating improvements and the associated 4-5% revenue enhancements.

3.5%

Estimated defensible RAF uplift with EquityIQ from accurate capture of social and functional risks often missed with traditional models

HealthyInsights.ai helps secure your plan’s financial integrity with the only verification engine that stabilizes V28 revenue variance to ±2% and cuts audit exposure by 40%, while unlocking a 3.5% defensible uplift through verified, equity-driven clinical truth.

- Dr. Jenni Gudapati, PhD, MBA, RN
Chief Policy Officer
Healthworx Technologies

Insert a quote referencing the bridging the gaps in care .

Medicare Advantage Opportunities

61%

of cognitive screening tests have test administration or scoring errors resulting in lower Cognitive Administration Integrity Rates (CAIR).

150%

increase in costs following delayed diagnosis of cognitive impairment vs. early detection impacting Crisis-to-Prevention Cost Ratios (CPCR)

1.56

times higher readmission risk from missed or unmanaged social risks directly affecting SDoH Adjusted Readmission Probabilities (SARP)

"In a risk-adjusted environment, data accuracy is crucial. Under-coding leads to missed HCC revenue and delayed patient care. Conversely, over-coding triggers unnecessary expenses that drive up your Medical Loss Ratio (MLR), and clawback risks. In either scenario, the patient, plan, and provider all lose."

Changing Regulatory Environment
(creating new opportunities)

CDMR

The Cognitive Detection & Management Rate addresses a "silent epidemic" that is fast becoming a primary driver of cost, poor outcomes, and audit risk in the aging MA population.

RADV

RADV fundamentally changes the risk profile of MA plans. The strategic shift to "Verification" is not just about earning bonuses; it is about avoiding existential legal and financial threats and managing to new enforcement mechanisms that escalate the cost of non-compliance.

26-29

2026–2029 will separate the "Data Aggregators" from the "Care Managers." Plans that continue to rely on volume-based HRA coding and engineering and administrative Star measures will face regulatory and financial obsolescence.

A2AI

The Assessment-to-Action Index is arguably the most critical metric for the 26–29 planning. This metric is countermeasure to the HRA-only diagnoses and aligns the plan with the mandate for substantiated risk adjustment.

EHO4

The Equity Gap Index or EHO4ALL is the regulatory requirement for plans to measure, report, and close gaps in care for underserved populations and remains a non-negotiable cornerstone of CMS policy for 26–29.

GUIDE

Guiding an Improved Dementia Experience Model represents a massive CMS investment in dementia care. Plans must have a robust mechanism to identify eligible beneficiaries and measure performance to capture PBPM .

- Dr. Rourke Yeakley, MD
Chief Medical Officer
HealthyInsights.ai

Our Medicare Advantage Value Proposition

"HealthyInsights.ai empowers your plan to transition from the vulnerability of volume-based risk capture to the stability of Verification-Based Reimbursement, directly countering the financial volatility of the CMS-HCC V28 model and heightened RADV scrutiny. By operating as a neutral Trust Infrastructure that unifies patient-reported data, NIH-validated cognitive screening (MyCog™), and social risk intelligence (EquityIQ™), we provide a single, audit-defensible source of truth that turns "black box" codes into clinically verified evidence. This provenance-rich approach not only secures your revenue against audit exposure by up to 40% but also reduces administrative abrasion for your provider network, automating the compliance documentation that traditional models fail to capture. Furthermore, our platform operationalizes the CMS Health Equity Framework to identify hidden cost drivers—like frailty and social barriers—upstream, directly fueling the engagement and care gaps closure required to protect and improve your Star Ratings. Investing in HealthyInsights.ai means replacing retrospective "chart chasing" with a proactive strategy that connects Clinical Truth to Fiscal Integrity, ensuring your financial outcomes are as healthy and authentic as the care you aim to deliver."