This article was originally published on RISE on November 2, 2023.

On March 31, 2023, Centers for Medicare & Medicaid Services (CMS) announced the gradual transition to V28 of the CMS-HCC model. Phased in over time, the plan is to switch completely to the updated model by 2025. This change has widespread implications and all health plans should already be thinking about transitioning to CMS-HCC V28. In this blog, we’ll explore how the new model will impact your risk adjustment program, why transitioning now to the blended model is a good idea, and how you can make this transition as seamless as possible.

The V28 Model: A New Horizon

The V28 model is more than just another update; it’s a fundamental change in the way health plans manage risk and assess patient populations. Estimates suggest this model will decrease Medicare Advantage risk scores anywhere between 3-8%. Such changes have far-reaching implications for health plans, impacting revenue, care planning, and overall strategic direction.

Here is a snapshot of the changes the new V28 model brings:

Transitioning Timeline

The V28 CMS-HCC risk adjustment model is here, and understanding the transition timeline is crucial. In 2023, the V24 model carries significant weight with 67%, while the new V28 model holds a 33% share. This balance undergoes a substantial shift in 2024, with 67% of the weight now assigned to the V28 model and only 33% to the V24 model. By 2025, the transition is complete, with the V28 model taking center stage at 100%.

Why Early Transition Matters

• Accuracy and Compliance: Early adoption ensures that health plans are well-prepared to accurately assess risk. This translates to better compliance with regulatory requirements and a reduced chance of compliance-related penalties.
• Strategic Planning: Transitioning early allows health plans to proactively plan for the expected decrease in revenue. It gives health organizations the time and insight needed to strategize for financial sustainability.
• Operational Efficiency: A seamless transition minimizes operational disruptions. Health plans can continue to focus on patient care and value-based partnerships without undue distractions.
• Competitive Advantage: Early adopters gain a competitive edge. They have the time and resources to adapt to the new model’s requirements and potentially outperform competitors.
• Improved Patient Outcomes: Early transition facilitates more accurate risk assessment of patient populations, which ultimately leads to better patient care planning and improved health outcomes.

How You Can Begin Transitioning

At Episource, we understand the challenges of transitioning to the V28 model. That’s why our innovative solution, Episource Analyst, has already been updated to accommodate the V28 model and make your transition seamless and efficient. Here’s what you can expect from Episource Analyst:

1. Comprehensive V28 Model Analysis: We provide a detailed analysis of how the V28 model impacts your organization. Our insights empower strategic decision-making and risk adjustment optimization.

2. Seamless Transition: Our user-friendly tools simplify the transition process, ensuring minimal disruption to your operations and a smooth shift to the blended model.

3. Revenue Optimization: We help you maximize revenue capture under the V28 model, aligning your financial strategies for peak profitability.

4. Proactive Risk Adjustment: Our tools enable prospectively planned care programs by analyzing risk scores and RAF opportunities, allowing for more precise member demographics and timely interventions.

5. Strategic Planning: We assist you in achieving mastery of the V28 model, giving you a competitive edge in the evolving healthcare landscape.

The V28 model is a significant change that necessitates early and seamless adoption. Health plans that transition early not only ensure compliance but also gain a competitive advantage while improving patient outcomes. At Episource, we are your strategic partner in navigating this transition successfully. Together, we can help you master the V28 model and lead the way in healthcare’s evolving landscape.