Medicare Advantage Plans

HealthyInsights.ai helps MA Plans move beyond mining for artificial uplift to capturing accurate health and cognitive intelligence that reveals your population's true medical needs and complexities.

Our platform helps drive proper care planning, address equity gaps, achieve cost containment, and adapt to new regulations with confidence.

Value Proposition

HealthyInsights drives verifiable health, cognitive, and risk capture through patient-driven assessments. A ~50% lift in wellness visit adherence yields ~0.15 new HCCs per visit — generating additional resources to address critical patient needs that are traditionally missed, ensuring comprehensive care when backed by AuditIQ and EquityIQ.

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

± 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.

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."

- Suzette Rahn
Chief Opreations Officer
HealthWorx Technologies

Hidden Cognitive Risk

Research confirms that cognitive impairment is a cost force multiplier, adding ~11% to annual medical spend for beneficiaries with identical risk profiles. Consequently, the 'undetection gap' in cognitive care has become the single fastest accelerator of preventable cost expansion in Medicare Advantage

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)

HealthyInsights and MyCog Mobile answers this challenge by replacing assumptions with verification and ensuring a plan captures the true acuity of its population while providing the audit-defensible provenance needed to manage the exponential risk.

"We bridge the gap in between plans, providers, beneficiaries, and regulators by rejecting the industry's obsession with mining risk uplift in favor of a neutral platform that captures accurate health and cognitive assessments, empowers providers to spend more time delivering care, and creates a defensible RADV position for the plan."

- Dr. Jenni Gudapati, PhD, MBA, RN
HealthyInsights.ai

Annual Wellness Opportunity

Research indicates that administrative friction and data fragmentation consume up to 40% of clinical time, suppressing Annual Wellness completion rates. HealthyInsights reduces this burden for provider and patient, recovering lost care delivery time, and driving AWV adherence from industry averages of ~30% to over 80%.

>85%

Targeted A2AI through accurate, verified whole-person health and risk capture, and verified care - also driving proportional improvements in Cognitive Administration Integrity Rates (CAIR).

40%

targeted reduction in provider administrative burden resulting in lower costs visits and significantly improving visit schedules, captured health and risk complexity, and delivered care plans.

50%

Improvement in cognitive impairment detection and resulting improvements in GUIDE Model participation and neurocognitive risk resources versus generic or missed screenings.

"Research confirms that the 'Action Gap' in legacy assessments leaves nearly 50% of identified risks undocumented, creating significant exposure to audit extrapolation. Consequently, the transition to Verification-Based Care has made Annual Wellness the definitive strategy for delivering healthy outcomes, and a projected 85.6% net ROI by transforming hollow diagnosis codes into audit-proof clinical evidence."

Regulatory Opportunities

Regulatory modernization shifted the financial center from 'Yield' to 'Integrity,' making RADV error rates and the Assessment-to-Action Index (A2AI) the new determinants of performance. HealthyInsights helps convert compliance liabilities into plan opportunities — securing GUIDE, EHO4, and protecting plans from the 'extrapolation risk'.

CDMR

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

RADV

he RADV shift to 'Verification' is more than plan performance, its also about avoiding existential legal and financial threats and managing new enforcement mechanisms that escalate non-compliance costs

26-29

2026–2029 will separate "Data Aggregators" from "Care Managers." Plans can no longer rely on volume-based HRA coding and uplift to avoid 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 transitions your plan from volume-based vulnerability to Verification-Based Care and Reimbursement, neutralizing V28 and RADV volatility. As a neutral Trust Infrastructure, MyCog™ Mobile and EquityIQ™ convert 'black box' codes into audit-defensible evidence. Together, this reduces audit exposure by 40%, minimizes provider abrasion, and protects Star Ratings — our ultimate goal is to connect Clinical Truth to Fiscal Integrity.

Learn More