Medicare Advantage Plan Sponsors

HealthyInsights helps plans shift from volume-based risk capture to a Verification-Based Reimbursement strategy. Our patient-driven platform empowers plans and providers while delivering the audit-proof evidence you need to navigate V28 and growing Part D liability,

Medicare Advantage Value Proposition

First Value MA Plans Can Expect from HI.AI

Second Value MA Plans Can Expect from HI.AI

Third Value MA Plans Can Expect from HI.AI

Fourth Value MA Plans Can Expect from HI.AI

2026-30 Plan Goals

Maximize Star Ratings via the Health Equity Index

Immunize Revenue Against Risk via Provenanced Data

Flatten the "Crisis Cost Curve" to Protect Margins

Decouple Clinical Insight from Provider Abrasion

INSERT STRONG CLOSING LINE HERE

Insert a quote referencing the building of a bridge between fee for service to value based healthcare and briding the gaps between stakeholders, etc.

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)

~7 Years

Minority populations often face a delay in dementia diagnosis of 3.5 to 7 years compared to other groups risking Equity Quality goals and Star Ratings.

"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 Changing
(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 .

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Insights moves goes beyond the traditional HRA with the first patient driven intelligence engine designed to bridge the gap between Clinical Truth and Fiscal Integrity - creating a single source of truth for payers, providers, and patients - and delivering healthier outcomes and improved plan metrics.

MyCog Mobile solves the limitations of manual in-clinic screening with the first NIH validated, patient driven cognitive assessment designed to bridge the gap between silent decline and actionable care - creating a precise, patient driven baseline for brain health that empowers earlier intervention and delivers the defensible evidence needed for accurate risk capture.

EquityIQ provides a dynamic intelligence engine designed to bridge the gap between Social Risk and Real-World Access — creating a quantified, audit-ready framework that transforms health equity from a regulatory mandate into a measurable driver of Fiscal Fairness and community connection.

AuditIQ solves the vulnerability of retrospective 'chart chasing' with a provenance-driven validation engine designed to bridge the gap between Clinical Evidence and Payment Integrity — creating an immutable, explainable ledger that transforms compliance into Verification-Based Reimbursement and ensures every financial outcome is backed by the indisputable 'who, when, and where' of its origin.

Great Patient is a patient facing platform that empowers patients to take an active role in their healthcare journey through a consumer-driven intelligence engine designed to bridge the gap between Lived Experience and Clinical Authority — creating a structured, AI-guided framework that transforms the patient journey from silence into Shared Decision-Making, ensuring every beneficiary has the knowledge, confidence, and directional guidance to sit as an equal partner on their own care team.

Medicare Advantage Value

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.