Strategy and Solutions
The client was a Medicare Advantage health plan serving approximately 450,000 members. With upcoming V28 Risk Adjustment Factor (RAF) changes, leadership needed better visibility into member risk profiles, documentation gaps, and provider performance. Existing reporting systems were fragmented and retrospective, limiting proactive intervention.
To strengthen risk adjustment accuracy and improve quality scores, the plan partnered with Zymr to build a modern population health analytics platform.
Data was spread across more than 185 source systems, making risk stratification slow and incomplete. HCC gaps were identified too late to influence coding or care delivery. Provider outreach efforts were manual and poorly coordinated. Leadership needed a scalable analytics foundation capable of supporting RAF optimization, quality improvement, and regulatory reporting.
Zymr helped the health plan move from retrospective reporting to proactive population health management. By combining scalable analytics with ML-driven risk insights, the organization improved financial performance, quality ratings, and regulatory readiness while strengthening provider collaboration.
Zymr designed and implemented a cloud-native population health and risk analytics platform.
Regulatory-Ready Reporting Framework
Supported CMS compliance and audit requirements.
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