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Risk Adjustment Consulting

Raise coding accuracy without raising audit exposure.

Large-plan rigor. Mid-market scale.

Risk-adjustment consulting for Medicare Advantage plans and provider-led ACOs. RADV-defensible. V28-ready. Quantified in the financial terms your CFO needs to approve the work.

Goal-oriented consulting for lead-generating growth initiatives

Experience across Medicare, ACA, and Medicaid risk-adjustment environments

Focus on measurable provider performance in value-based activities

AI-accelerated analysis, with my judgment behind every recommendation

Who I Help

Prior engagements across payer and provider markets

Direct experience advising the plans and providers below across Medicare Advantage, ACA, Medicaid, and commercial risk-adjustment programs.

Blue Cross health plans
Regional payers
Healthcare providers
Payviders

Past Clients

Premera Blue CrossMolina HealthcareCambia Health SolutionsOptum CarePacificSource Health PlanEXL Health
Services

Consulting designed for healthcare organizations under performance pressure

These engagements are built to diagnose performance gaps quickly and drive measurable outcomes across payer, provider, and payvider models.

Where to start

Quick Wins Analysis

A 30-day, fixed-fee diagnostic — the fastest way to see whether there's meaningful, defensible capture opportunity in your population.

You send a de-identified claims and HCC capture extract. I run it through AI-accelerated analysis — pattern-finding and prioritization across your population at the data level — and return a prioritized opportunity list, tiered by likelihood and ease of valid capture, with PMPM impact estimates, implementation-effort scores, and clinical and operational next steps. The analysis is fast; the judgment is mine — every conclusion is reviewed before it reaches you. It stands on its own — even if the engagement ends at day 30, your team has an actionable list for the current performance year.

Risk Adjustment Strategy

Assess your current-state program and prioritize the highest-impact interventions across coding, documentation, and analytics.

Program Effectiveness Reviews

Identify where your risk-adjustment workflows break down and implement practical fixes across operations and partner performance.

Value-Based Performance Enablement

Align risk-adjustment strategy with value-based care objectives so providers, market leaders, and analytics teams execute from one plan.

Operating Model Transformation

Restructure teams, vendor oversight, and reporting rhythms to scale risk-adjusted performance across regions and lines of business.

Need to improve risk-adjustment performance this quarter?

Book a working session to review your current program and identify the highest-impact operational changes.