Generated by All in One SEO v5.0.0.1, this is an llms.txt file, used by LLMs to index the site. # Pareto Intelligence ## Sitemaps - [XML Sitemap](https://paretointel.com/sitemap.xml): Contains all public & indexable URLs for this website. ## Posts - [2018 ACA Risk Adjustment Transfer Payment Results: “Premium Stabilization Program” Beginning to Stabilize](https://paretointel.com/2018-aca-risk-adjustment-transfer-payment-results-premium-stabilization-program-beginning-to-stabilize/) - On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days of the announcement, Pareto published a preliminary analysis highlighting major trends and year-over-year comparisons into state average metrics, issuer transfer payments, and high-cost risk pool ## Pages - [Healthcare Data Analytics & Activation | Pareto Intelligence](https://paretointel.com/) - Pareto delivers predictive insights, advanced analytics, and advisory expertise to help health plans and providers improve financial, risk adjustment, Star, and member outcomes. - [Solution - Premium Integrity](https://paretointel.com/revenue-iq-premium-integrity/) - Recover underpaid premiums and ensure CMS compliance. Pareto Intelligence helps plans resolve MSP and ESRD status errors with predictive payment reconciliation. - [Solution - RevenueIQ](https://paretointel.com/revenue-iq/) - Improve accuracy and transparency for health plans and providers. Pareto RevenueIQ delivers defensible revenue outcomes through predictive intelligence. - [Solution - Rewards & Incentives](https://paretointel.com/rewards-iq/) - Drive member activation and improve Star Ratings. Pareto RewardsIQ uses predictive analytics to deliver personalized, compliant incentives for health plans. - [Solution - Payment Integrity](https://paretointel.com/payment-integrity-iq/) - Recover overpayments and prevent leakage. Pareto Intelligence unites Section 111, MSP, and COB validation with root-cause analytics for healthcare organizations. - [Solution - Star & Quality](https://paretointel.com/star-iq/) - Improve Medicare Advantage Star Ratings and member outcomes. Pareto StarIQ delivers predictive insights to optimize HEDIS, CAHPS, and QI performance. - [Solution - Risk Analytics](https://paretointel.com/revenue-iq-risk-adjustment/) - Improve risk adjustment accuracy and audit readiness. Pareto Intelligence helps health plans and providers identify coding gaps and reduce compliance risk. - [FAQ - Revenue IQ - Risk Adjustment](https://paretointel.com/revenueiq-faq/) - Explore the RevenueIQ FAQ. Understand how Pareto's risk adjustment solutions help health plans improve accuracy, compliance, and program performance. - [Resources Hub](https://paretointel.com/resources-hub/) - Resources Insights Webinars Tools & Reports Success Stories Product Resources Insight The Pareto Effect on Two Clients’ HHS-RADV Performance When two ACA issuers faced the same audit cycle with different levels of RADV support, the financial gap between them reached into the millions, making this a must-read for any Read more See How We Can - [RADV Audit Support for Medicare Advantage | Pareto](https://paretointel.com/radv-cms-audits/) - Get expert RADV audit support for Medicare Advantage plans. Pareto helps with chart strategy, coding, retrieval, and financial impact analysis. - [Solution - Execution](https://paretointel.com/consulting-and-managed-services/) - Turn healthcare strategy into outcomes. Pareto Intelligence embeds expert operators with analytics to improve risk accuracy, Star Ratings, and compliance. - [Audience - Medicare](https://paretointel.com/medicare-health-plans/) - Pareto helps Medicare Advantage plans improve Star Ratings, strengthen compliance, optimize RAF, and protect revenue with predictive analytics and turnkey execution. - [Contact Us](https://paretointel.com/contact/) - Contact Us Ready for Results? Let’s Talk. If you’re a healthcare leader focused on improving financial performance, quality outcomes, and member engagement, you’re in the right place.Pareto partners with health plans and providers across Medicare, Medicaid, the Health Insurance Exchange and Commercial markets to turn complex data into measurable results. Whether you’re exploring our analytics - [Audience - Commercial Plans](https://paretointel.com/commercial-health-plans/) - Pareto helps commercial health plans lower cost of care, improve claims accuracy, and engage members with predictive analytics, turnkey execution, and employer-ready reporting. - [Audience - Medicaid](https://paretointel.com/medicaid-health-plans/) - Pareto helps Medicaid MCOs improve encounter data accuracy, payment integrity, compliance readiness, and member engagement with predictive analytics and turnkey execution. - [Audience - Healthcare Exchange](https://paretointel.com/aca-marketplace-plans/) - Pareto helps ACA Marketplace plans improve premium reconciliation, risk adjustment accuracy, payment integrity, and member retention with predictive analytics and turnkey execution. - [Audience - Who We Serve](https://paretointel.com/who-we-serve/) - Modern Solutions for Health Plans and Risk-Bearing Providers Partnering with health plans and providers to improve quality, risk, and financial performance. Talk to an expert Pareto Intelligence helps health plans and providers boost quality, and revenue across Medicare Advantage, Medicaid, ACA Marketplace, and commercial markets. Our audience-specific analytics, engagement, and program performance solutions—including Star Rating - [About Us](https://paretointel.com/the-pareto-way/) - Learn how Pareto Intelligence, part of the Convey Health Solutions family, applies the 80/20 principle to transform healthcare through focus, data, and collaboration. - [All Insights](https://paretointel.com/insights/) - Gain Insights From the Experts Explore the latest perspectives, success stories, and news from Pareto Intelligence—built to help health plans stay ahead of the market, evolve strategies, and improve performance. Contact an expert Featured Article There's a Hole in Your Rewards Bucket Sarah opens her mail to find your colorful brochure promising $200 in rewards - [Healthcare Data Management Platform](https://paretointel.com/our-technology/) - The heart of Pareto is our intelligent data platform Our intelligent data platform seamlessly collects, aggregates, and organizes healthcare data to deliver analytics and technology solutions that help clients optimize revenue, lower costs, improve quality of care, and ultimately achieve better outcomes. We focus on understanding the impact of all data sources, while also applying - [Our People](https://paretointel.com/our-people/) - Discover career opportunities at Pareto Intelligence, a Convey Health Solutions company. Build your future where data, purpose, and impact come together. - [Careers](https://paretointel.com/careers/) - Discover career opportunities at Pareto Intelligence, a Convey Health Solutions company. Build your future where data, purpose, and impact come together. - [Demo](https://paretointel.com/demos/) - Request a live demo or watch on-demand walk-throughs of Pareto solutions. See how analytics and engagement tools drive risk, Star, and compliance outcomes. - [Success Stories Listings](https://paretointel.com/success-stories/) - Success Stories How Blue Cross of Idaho Modernized Provider Communication to Improve Risk & Quality Outcomes Blue Cross of Idaho improved provider engagement and risk documentation by delivering clinical insights directly into provider workflows. read More Improving Medicare Advantage Risk Submission Accuracy Through Data Integrity Analytics See how a Medicare Advantage plan identified $3M in - [404](https://paretointel.com/404-2/) - Page Not Found The page you’re looking for does not seem to exist Back to homepage - [Webinars](https://paretointel.com/webinars/) - Webinars Webinar Beyond the Noise: Insights on the 2026 CMS Star Ratings Discover insights from the 2026 CMS Star Ratings, trends affecting MA plans, and strategies for improvement from industry experts. Watch Now Webinar How to Accelerate Your Risk Adjustment Strategy Unlock insights into your risk adjustment data, enhancing transparency and allowing for data-driven strategies. - [Tools & Reports](https://paretointel.com/tools-reports/) - Tools & Reports Interactive Analysis: 2025 ACA Risk Adjustment Transfer Payment Results Pareto’s interactive dashboard lets you explore the 2025 ACA risk adjustment transfer payment results by issuer and state. You can analyze multi-year trends, compare plan performance, and uncover insights to... More Info Interactive Analysis: 2024 ACA Risk Adjustment Transfer Payment Results On June - [Login](https://paretointel.com/login/) - Pareto Application Login To maintain our high security standards, Pareto allows only certain IP addresses to log in. Please be sure to connect to your company’s VPN or network before accessing the Pareto Application. To ensure the best user experience, we recommend using the most recent version of Chrome, Edge, or Safari. Log in If - [Terms Conditions](https://paretointel.com/terms-conditions/) - Terms of Use Thank you for visiting the Pareto website, provided to you by Pareto Intelligence. This document sets forth the terms and conditions that apply to your use of the Pareto website. If you do not accept these terms and conditions, do not use this Site.Terms of Use AgreementThe effective date of this Terms - [Privacy Policy](https://paretointel.com/privacy-policy/) - Privacy Policy PRIVACY POLICY – COMMITMENT TO YOUR PRIVACY The Effective Date of this Privacy Policy is August 1, 2018. This version of the policy replaces and supersedes any prior privacy policies applicable to this website. SUMMARY AND CONTACT INFORMATION We at Pareto Intelligence (referred to as “Pareto”) recognize the importance of protecting the privacy - [Recruitment Fraud Disclaimer](https://paretointel.com/recruitment-fraud-disclaimer/) - Recruitment Fraud Disclaimer What is Recruitment Fraud?Recruitment fraud is a growing national trend where fraudsters attempt to use an employer’s name to trick job seekers with fake employment opportunities. This type of fraud is typically carried out through fake job postings, fake websites, or email accounts claiming to be from the employer. The goal of - [Homepage](https://paretointel.com/homepage/) - Empowering Your Business with Technology 01 IT CONSULTING & STRATEGY Develop a roadmap for success with expert guidance and actionable insights to optimize your IT infrastructure 02 MANAGED IT SERVICES Focus on your core business while we manage, monitor, and maintain your IT systems with 24/7 support. 03 CLOUD SOLUTIONS Migrate, manage, and optimize your ## Authors - [Brandon Solomon, Senior Vice President & General Manager](https://paretointel.com/pareto_author/brandon-solomon-senior-vice-president-general-manager/) - Brandon first joined Pareto in 2018, leading all customer-facing operations and business development. In his current role, he focuses on developing strong partnerships with healthcare clients to help them attract, retain, and better manage members with advanced technology and analytic solutions. He is responsible for the strategic growth and performance of the organization, both through - [JEAN BECKER, DATA ANALYST](https://paretointel.com/pareto_author/jean-becker-data-analyst/) - As a data analyst at Pareto, Becker contributes to the design and implementation of advanced features that strengthen our core solutions and increase market impact. With a strong foundation in data and a mindset for growth, Becker brings both technical skill and a collaborative approach to every project—enhancing the depth, usability, and value of our - [RORY NEBEL, ASSOCIATE, CLIENT ADVISORY](https://paretointel.com/pareto_author/rory-nebel-associate-client-advisory/) - As a member of the Client Advisory team, Rory supports the delivery of Pareto’s solutions and provides strategic guidance to healthcare clients. With a focus on execution and relationship-building, Rory helps plans understand and apply insights that drive performance and long-term value. - [Damian Kearney, Vice President, Analytics](https://paretointel.com/pareto_author/damian-kearney-vice-president-analytics/) - Damian Kearney is the vice president of analytics at Pareto, bringing over a decade of experience in strategy consulting, Medicare Advantage Stars business outcomes, and advanced analytics. His background includes roles at McKinsey & Company, Highmark Blue Cross Blue Shield, and Elevance Health. Damian is a deep subject matter expert in all technical components of - [Lulu Zhang, Data Analyst](https://paretointel.com/pareto_author/lulu-zhang-data-analyst/) - As a Data Analyst on Pareto’s Stars team, Lulu supports the Star Analytics Solution, which empowers clients to make smarter, data-informed decisions in the Medicare Advantage space. She stays current on the latest CMS updates and industry trends to ensure the solution remains aligned with evolving regulatory and market dynamics. - [Senior Associate, Client Advisory](https://paretointel.com/pareto_author/senior-associate-client-advisory/) - Kristi is a Client Advisory Associate, dedicated to helping clients use data analytics and technology solutions to navigate the continuously changing healthcare landscape. Her previous experience as a consultant with Pareto's sister company, HealthScape Advisors, gives her a unique understanding of the challenges clients are facing and how to use data to overcome them. - [David Thompson, Data Science Manager](https://paretointel.com/pareto_author/david-thompson-data-science-manager/) - As Data Science Manager, David oversees the development of the advanced analytics, predictive models and proprietary algorithms that support the solutions Pareto offers. He has developed pricing strategies, provider performance evaluation techniques, exchange readiness strategies, predictive risk gap algorithms, medical utilization trend reporting and more to help clients solve complex business problems. - [Austin Bostock, Director, Business Development](https://paretointel.com/pareto_author/austin-bostock-director-business-development/) - Austin is the Director of Business Development, focused on the implementation and delivery of Pareto's solutions as well as ongoing industry advisory to various healthcare clients. His combined engineering and business backgrounds allows him to bring an analytical approach to solving problems and supporting revenue management improvement activities for clients. - [Administrator](https://paretointel.com/pareto_author/administrator/) - [Matt Krizmanich, Vice President, Client Advisory & Business Development](https://paretointel.com/pareto_author/matt-krizmanich-vice-president-client-advisory-business-development/) - Matt co-leads Pareto's Client Advisory and Business Development teams, with a focus on revenue and payment reconciliation solutions for health plan and provider clients. His subject matter expertise in Medicare Secondary Payer (MSP), Medicare Coordination of Benefits (COB), Section 111 Mandatory Insurer Reporting, and more allows him to capture significant recoveries for clients, totaling over - [Zain Jafri, Vice President, Innovation & Analytics](https://paretointel.com/pareto_author/zain-jafri-vice-president-innovation-analytics/) - Zain leads Pareto’s Innovation and Analytics team. He is responsible for building new analytics capabilities and pursuing innovation opportunities at Pareto. He also oversees the development and commercialization of emerging products, while keeping an ear to the market and our clients’ needs to identify new problems to solve or how new features (e.g., machine learning, - [William Payne, Data Analyst](https://paretointel.com/pareto_author/william-payne-data-analyst/) - As a Data Analyst, Will uses big data and complex analytical tools to tease out relevant and compelling insights for innovation initiatives. He designs reports and visualizations, as well as provides backend support and data quality assurance to ensure accurate analysis and reporting. - [Jason Montrie, President](https://paretointel.com/pareto_author/jason-montrie-president/) - As President, Jason provides strategic leadership and oversight in pursuit of Pareto’s mission to build innovative, practical analytics and technology solutions. With the ever-increasing volume and velocity of healthcare data, Jason’s leadership keeps Pareto ahead of client needs, always anticipating “what’s next” and helping healthcare organizations harmonize disparate data and translate it into actionable insights - [Jeff De Los Reyes, VP, Risk Adjustment, GHG Advisors](https://paretointel.com/pareto_author/jeff-de-los-reyes-vp-risk-adjustment-ghg-advisors/) - Jeff De Los Reyes is the leader of the Risk Adjustment division at Pareto's sister company, GHG Advisors. In this role, health plans and providers look to Jeff to enhance, optimize, and ensure superior outcomes related to revenue accuracy and compliance across all government- and state-sponsored programs (Medicare, Medicaid, and ACA). - [Data Analytics Manager](https://paretointel.com/pareto_author/data-analytics-manager/) - Tracy manages Pareto's Data Analytics team, leveraging her expertise in data analysis and process improvement to drive productivity and performance. She provides leadership and guidance across our analytics initiatives to enhance current products, launch new products and help us stay ahead of industry trends. - [Data Scientist](https://paretointel.com/pareto_author/data-scientist/) - Thrisha is a member of our Data Science team with proven success developing models that present targeted and actionable outputs. She has experience with a variety of model types (e.g., clustering, regression, isolation forests, CART) as well as programming languages (e.g., Python, R). - [Steven Singer, Client Advisory Analyst](https://paretointel.com/pareto_author/steven-singer-client-advisory-analyst/) - Steve is a Client Advisory Analyst at Pareto, with a strong background in data analytics. He delivers impactful results for our clients through the ability to provide actionable, data-driven recommendations that solve complex business problems. - [Rick Monaco, Vice President, Risk Solutions](https://paretointel.com/pareto_author/rick-monaco-vice-president-risk-solutions/) - Rick brings over 20 years of experience to Pareto Intelligence and GHG Advisors, with extensive experience in leading, developing, and executing on strategic initiatives within the healthcare ecosystem. This includes more than 15 years of dedicated emphasis in government programs, specifically assisting health plans design analytic strategies for comprehensive and accurate data capture to support - [Eric Shapiro, Vice President, Risk Adjustment Consulting](https://paretointel.com/pareto_author/eric-shapiro-vice-president-risk-adjustment-consulting/) - Eric Shapiro is a Principal of Risk Adjustment at Pareto Intelligence and GHG Advisors. He is responsible for the execution and oversight of risk adjustment projects across all government and state-sponsored programs (Medicare, Medicaid, and ACA). Eric brings over 15 years of healthcare experience to Pareto, working closely with health plans, health services organizations, and - [Tom Field, Senior Data Analyst](https://paretointel.com/pareto_author/tom-field-senior-data-analyst/) - As a Senior Data Analyst, Tom uses big data and complex analytical tools to extract informative and compelling insights for innovation initiatives. With a background in data engineering, Artificial Intelligence, and data science, he helps design and build our end-to-end solutions - all the while providing backend support and data quality assurance to ensure accurate - [Fiona Dassum, Senior Data Analyst](https://paretointel.com/pareto_author/fiona-dassum-senior-data-analyst/) - Fiona Dassum is a Senior Data Analyst at Pareto Intelligence. She is responsible for developing, implementing, and supporting our end-to-end solutions. With a background in data analytics and information Systems, she delivers critical insights for our clients through her ability to interpret and handle data, assuring quality analysis and reporting. - [Christopher Steibel, Manager, Client Advisory](https://paretointel.com/pareto_author/christopher-steibel-manager-client-advisory/) - As the manager of client advisory, Christopher is focused on the delivery of Pareto's solutions as well as ongoing industry advisory to various healthcare clients. - [Pooja Denchanala](https://paretointel.com/pareto_author/pooja-denchanala/) - As a data analyst driven by curiosity and a passion for continuous learning, Pooja thrives on exploring new methodologies and technologies. Her enthusiasm for discovering innovative approaches has led her to update and refine existing solutions, significantly enhancing product performance. By merging her analytical skills with a commitment to staying current, Pooja contributes to more - [Kimberly Switlick-Prose, MPH, Vice President, Quality](https://paretointel.com/pareto_author/kimberly-switlick-prose-mph-vice-president-quality/) - As Vice President of Quality at Pareto Intelligence, Kimberly Switlick-Prose leverages over 20 years of experience to develop innovative strategies that enhance healthcare outcomes and create value through behavioral design. Known for her ability to drive collaboration and utilize data-driven insights, she has successfully led initiatives that optimize quality processes and improve member engagement. A ## Insights - [The Pareto Effect on Two Clients’ HHS-RADV Performance](https://paretointel.com/insight/radv-support-financial-impact-case-study/) - Discover how two ACA issuers facing the same audit cycle arrived at vastly different financial outcomes based solely on their level of RADV support. - [Interactive Analysis: 2023 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/2023-aca-risk-adjustment-transfer-payment-results/) - On July 22, 2024, the Department of Health and Human Services (HHS) unveiled the highly anticipated Summary Report on Risk Adjustment Transfer for the 2023 Benefit Year. This report dives into risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. In an effort to simplify the data and enhance understanding, - [Interactive Analysis: 2024 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/2024-aca-risk-adjustment-transfer-payment-results/) - On June 30th, 2025, the Department of Health and Human Services (HHS) unveiled the highly anticipated Summary Report on Individual and Small Group Market Risk Adjustment Transfers for the 2024 Benefit Year. This report dives into risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. In an effort to simplify - [Interactive Analysis: 2025 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/2025-aca-risk-adjustment-transfer-payment-results/) - Explore the 2025 ACA risk adjustment transfer payment results with Pareto’s free interactive tool. Compare trends, visualize data, and share insights. - [Interactive Analysis: 2022 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/interactive-analysis-2022-aca-risk-adjustment-transfer-payment-results/) - On June 30, 2023, the Department of Health and Human Services (HHS) unveiled the highly anticipated Summary Report on Risk Adjustment Transfer for the 2022 Benefit Year. This report dives into risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. In an effort to simplify the data and enhance understanding, - [CMS’ Race to Validate: Navigating the Rapid RADV Era](https://paretointel.com/insight/cms-radv-audit-race/) - Facing a CMS RADV audit? Learn how to prepare, reduce risk, and protect revenue with expert-backed strategies. - [Improving Medicare Advantage Risk Submission Accuracy Through Data Integrity Analytics](https://paretointel.com/insight/success-story-data-integrity-medicare-advantage/) - A MA plan used Pareto analytics to identify data integrity gaps across the encounter-to-submission process, uncovering $3 million in suppressed risk transfer. - [The 3 Biggest Star Takeaways From The 2027 MAPD Rule](https://paretointel.com/insight/2027-final-rule-star-ratings-impact/) - Significant headwinds are facing Health Plans when it comes to Stars, per the finalized 2027 MAPD Rule. If you're reading this, there is a good chance you're familiar with those changes, but, in summary, CMS is removing 11 of the ~40 Star measures from the measure set over the next couple of years, while adding Discover the three biggest takeaways from the finalized 2027 MAPD Rule and how health plans can navigate the removal of key Star measures. Learn actionable strategies to maintain performance amidst increased volatility. - [Analysis of COVID-19 and Telehealth Impact on Risk Adjustment](https://paretointel.com/insight/covid-19-telehealth-risk-adjustment-analysis/) - As COVID-19 continues to invade our personal and professional lives, every day brings new changes for the healthcare industry. Not long ago, health systems and provider organizations were instructed by the Centers for Medicare and Medicaid Services (CMS) to postpone, cancel or redirect any nonessential office visits, and even to limit in-person essential services, so that clinicians - [Analysis of the 2020 Medicare Advantage Annual Enrollment Period (AEP) Results](https://paretointel.com/insight/2020-annual-enrollment-period-aep-results-analysis/) - Medicare Advantage (MA) continues to be an attractive market with continually expanding membership and increasing investment by MA organizations (MAOs) to capture market share. Now that the dust has settled post-Annual Enrollment Period (AEP), and CMS has released February monthly membership enrollment data, we have granular insight into the shifts in membership resulting from 2020 AEP. - [The Real Job of a Star Ratings Team](https://paretointel.com/insight/value-of-star-ratings-teams/) - A tough question “So why does the Stars team need to exist?” It was a provocative question from a C-Suite leader at a health plan I worked for. We had just provided him with an overview of how our company’s Star operating model. The Star team didn’t “do” anything. We weren’t closing gaps or chasing MA plan Star teams don't close gaps or run call centers, so what do they do? A practitioner breaks down the real value of Stars program leadership. - [Pareto Intelligence Launches StarIQ to Bring Predictive Intelligence to Medicare Advantage Star Ratings](https://paretointel.com/insight/pareto-intelligence-launches-stariq-to-bring-predictive-intelligence-to-medicare-advantage-star-ratings/) - Move your Medicare Advantage plan beyond static reporting toward predictive insights and execute on your best path toward Star Rating improvement with Pareto StarIQ. - [PY2027 Advance Notice Deep Dive: Impact of Unlinked Supplemental Submissions](https://paretointel.com/insight/cms-2027-advanced-notice-supplemental-submissions-analysis/) - CMS proposes eliminating unlinked supplemental records in 2027. Pareto analysis reveals 1.3% average RAF impact for MAOs. Learn what to do next. - [Avoiding Regulatory Scrutiny Through a Strong Risk Adjustment Compliance Culture](https://paretointel.com/insight/risk-adjustment-compliance-culture/) - Learn how health plans can reduce audit risk by building a strong risk adjustment compliance culture that aligns incentives, improves documentation, and strengthens governance. - [Medicare Advantage Star Ratings: Were you surprised by the Star results?](https://paretointel.com/insight/navigating-star-ratings-challenges/) - Explore why Medicare Advantage Star Ratings are becoming harder to achieve and what health plans must consider as CMS policies and performance thresholds evolve. - [An Olive Branch and an Alarm Bell: Implications of the Final Rule and Rate Notice on Star Rating Performance](https://paretointel.com/insight/star-ratings-strategy-cms-final-rule/) - Learn how the CMS Final Rule affects Medicare Advantage Star Ratings and what health plans should prioritize to strengthen quality strategy and performance. - [What Is Star Year 2026 CAHPS Data Really Telling Medicare Advantage Plans?](https://paretointel.com/insight/medicare-advantage-cahps-trends-2026/) - Analyze 2026 Medicare Advantage CAHPS trends, state-level performance shifts, and what patient experience data may signal for Star Ratings strategy. - [There’s a Hole in Your Rewards Bucket](https://paretointel.com/insight/medicare-advantage-rewards-programs-member-engagement/) - Learn how health plan rewards programs drive member engagement and why personalization and data-driven outreach are critical to improving participation and outcomes. - [2018 ACA Risk Adjustment Interim Report: Huh, Yeah, What is it Good For?](https://paretointel.com/insight/2018-aca-risk-adjustment-interim-report/) - Though there are challenges to interpreting the results of CMS’ annual interim risk adjustment report, the answer to the question “what is it good for?” is certainly not “absolutely nothing.” CMS’ annual interim risk adjustment report provides many health plans with their first insights into the risk of their state market and their relative position, outside of - [Over $150 Million in Inaccurate Revenue Identified by Pareto Intelligence’s Data Integrity Solution](https://paretointel.com/insight/over-150-million-in-inaccurate-revenue-identified-by-pareto-intelligences-data-integrity-solution/) - See how Pareto’s RevenueIQ data integrity analytics uncovered over $150M in inaccurate revenue tied to encounter data quality and reporting issues. - [Large Regional ACO Improves the Accuracy of Risk Submissions With Pareto Intelligence’s Revenue Integrity Solution](https://paretointel.com/insight/large-regional-aco-improves-the-accuracy-of-risk-submissions-with-pareto-intelligences-revenue-integrity-solution/) - A large regional ACO improved risk submission accuracy after identifying encounter data quality issues, resulting in $4.7M in financial improvement opportunity. - [Establishing a Successful Prospective Medicare Advantage Risk Documentation Program](https://paretointel.com/insight/establish-successful-prospective-medicare-advantage-risk-documentation-program/) - Medicare Advantage Organizations (MAOs) are constantly evaluating and deploying new strategies to improve risk documentation accuracy, though very few are able to achieve their desired risk adjustment factor (RAF) improvement targets. When this happens, MAOs will expand their retrospective chart review campaigns in an attempt to make up the difference. This strategy is costly, abrasive - [Improving Medicare Advantage Premium Accuracy Through Member Status Analytics](https://paretointel.com/insight/success-story-premium-integrity/) - A multi-state Medicare Advantage plan identified $11.5M in premium payment improvement by uncovering member status inaccuracies affecting CMS capitation payments. - [How a Blue Plan Improved Revenue Accuracy Across MA & ACA](https://paretointel.com/insight/success-story-revenue-payment-integrity/) - See how a Blue plan uncovered over $10M in revenue improvement opportunities by evaluating risk documentation, encounter data integrity, and coordination of benefits. - [How a Health System Identified $4.7M in Financial Opportunity in Value-Based Contracts](https://paretointel.com/insight/success-story-value-based-reimbursement-2/) - Value-Based Reimbursement Success Story THE SITUATION A health system with 40,000 Medicare Advantage (MA) members across multiple payers engaged Pareto Intelligence to evaluate internal encounter processes as well as the submission accuracy of their payer partners. THE SOLUTION Pareto deployed Payer Data Validation as part of its Value-Based Reimbursement Solution to complete a comprehensive evaluation - [How an ACA Plan Identified $7.7M in Suppressed Risk Transfer](https://paretointel.com/insight/success-story-data-integrity-aca/) - An ACA issuer uncovered $7.7M in suppressed risk transfer by identifying encounter submission errors and data integrity gaps affecting EDGE server submissions. - [Oak Street Health Partners with Pareto Intelligence to Improve Revenue Accuracy](https://paretointel.com/insight/oak-street-health-partners-with-pareto-intelligence-to-improve-revenue-accuracy/) - Oak Street Health partners with Pareto Intelligence to identify data quality issues affecting Medicare Advantage risk submissions and improve revenue accuracy across its population. - [How Blue Cross of Idaho Modernized Provider Communication to Improve Risk & Quality Outcomes](https://paretointel.com/insight/blue-cross-idaho-pareto-intelligence-provider-communication-strategy/) - BC Idaho partners with Pareto Intelligence to modernize provider communication, delivering clinical insights directly into workflows to improve risk and quality outcomes. - [What is the Impact of Expanded Supplemental Benefits in Medicare Advantage?](https://paretointel.com/insight/expanded-supplemental-benefits-flexibility-medicare-advantage/) - Beginning in performance year 2019, CMS awarded Medicare Advantage Organizations (MAOs) greater benefit flexibility through the creation of newly accepted (or expanded) supplemental benefits. Many health plans approached 2019 product design with a “wait and see” mentality, as most wanted to evaluate how competitors may incorporate these benefits before taking action. January 2019 enrollment provides - [We don’t just love healthcare data…](https://paretointel.com/insight/thanksgiving-by-the-numbers/) - You might call us data dorks. Knowledge nerds. Or just geeks… in general. Why’s that? Well this year, we decided to dive deeper into the data behind everyone’s favorite food holiday—Thanksgiving! Would you be surprised to know that pumpkin is the most popular choice for pie? Or that stuffing is the top side dish? How - [Using Social Determinants of Health to Combat COVID-19](https://paretointel.com/insight/social-determinants-of-health-sdoh-combat-covid-19/) - With the total number of confirmed coronavirus cases around the world surpassing 4 million in May, COVID-19 has become one of the worst pandemics in history, and it all happened in what seems like the blink of an eye. As coronavirus disease has ravaged the globe, there likely isn’t a single person who hasn’t experienced a change in - [Understanding the 2020 Medicare Advantage and Part D Rate Announcement & Final Call Letter](https://paretointel.com/insight/2020-medicare-advantage-final-call-letter/) - In April, the Centers for Medicare & Medicaid Services (CMS) released final policy and payment updates to the Medicare Advantage (MA) and Part D programs through the 2020 Rate Announcement and Final Call Letter. While there are many themes contained in the full document, one major takeaway stood out. Despite extensive comments from stakeholders, CMS - [Preliminary Analysis of ACA Risk Adjustment Transfer Payments for 2017](https://paretointel.com/insight/2017-aca-risk-adjustment-transfer-payments/) - On July 9th, 2018, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfers for the 2017 Benefit Year. This report outlines risk adjustment transfers by issuer and state. The interactive dashboards below provide initial insight and allow for year-over-year comparisons. This post will be followed by an in-depth - [The Last Puzzle Piece: Final Risk Adjustment Coefficients for 2018](https://paretointel.com/insight/final-risk-adjustment-coefficients-2018/) - The Department of Health and Human Services (“HHS”) recently released the much anticipated Final Risk Adjustment Model Coefficients for the 2018 Benefit Year. This updated report finalizes the risk coefficients for demographics, diagnosis codes (hierarchical condition category [“HCC”]), prescription drug class (“RXC”), and HCC + RXC interactions that were published as draft in the 2018 Notice - [The Age of Audits: Why You Need to Re-evaluate Your Risk Adjustment Strategy](https://paretointel.com/insight/updating-your-risk-adjustment-strategy/) - Updated August 2022: The following blog was originally published in October 2021. Since then, several new findings were released by OIG/DOJ related to the alleged overstating of Medicare Advantage beneficiary health status for risk adjustment purposes. These new findings include: September 2021: Operating on a 20% contingency fee, an organization submitted conditions not documented during the - [Tech-Focused MA Startups Chase Tailwinds in New Markets](https://paretointel.com/insight/tech-focused-ma-startups-chase-new-markets/) - Reprinted with AIS Health permission from the September 3, 2020, issue of RADAR on Medicare Advantage. In advance of the 2021 Medicare Annual Election Period (AEP) that starts on Oct. 15, venture-backed Medicare Advantage firms like Alignment Healthcare and Clover Health are unveiling their plans for expansion while new startup insurers are declaring their intentions. Although - [Success of PPOs, OTC Coverage May Drive 2021 MA Offerings](https://paretointel.com/insight/ppos-otc-drive-medicare-advantage-success/) - Reprinted with AIS Health permission from the April 2, 2020, issue of RADAR on Medicare Advantage. Although individual HMO plans continued to capture the bulk of enrollment in Medicare Advantage plans during the 2020 Annual Election Period (AEP), overall gains by individual PPO plans were not far behind those of the historically popular HMOs, according to a - [Spotlight on the 2019 Medicare Advantage Annual Enrollment Period Results](https://paretointel.com/insight/2019-medicare-advantage-annual-enrollment-period-analysis/) - Late last week, CMS released the final Annual Enrollment Period (AEP) results data that details the most accurate 2019 Medicare Advantage (MA) enrollment information. Using our Pareto Spotlight solution, Pareto aggregated and analyzed the data to understand changes in enrollment and the impact of 2019 product strategies. The dashboard below provides an interactive analysis of - [See How Pareto Leaders are Moving the Company Forward](https://paretointel.com/insight/pareto-intelligence-built-in-chicago-leadership-spotlight/) - It's not always easy navigating the intersection of healthcare and technology. Both bring with them a complex infrastructure and language that is constantly changing and evolving. In a recent Built In Chicago article, we illustrate how Pareto's leadership team guides the company through the intricate and obscure network of healthcare technology. Leadership in Healthcare Technology This article - [Risk Adjustment Priorities: Connecting Medicare Advantage Supplemental Data & Encounter Data](https://paretointel.com/insight/connecting-supplemental-data-encounter-data/) - After the November release of the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) report, 2022 Top Unimplemented Recommendations for HHS programs, I wrote a LinkedIn post about the Medicare Advantage-related recommendations. Recommendations that should capture the attention of all MAOs. The OIG found that MAOs use retrospective chart reviews and - [RAPS Submission Deadline for Payment Year 2017 Extended To May 4, 2018](https://paretointel.com/insight/2017-raps-submission-deadline-extended/) - On January 26th, the Centers for Medicare and Medicaid Services (CMS) announced an extension to the Final Reconciliation deadline for Payment Year (PY) 2017 Risk Adjustment Processing System (RAPS) data submissions. The previously reported deadline of January 31, 2018 will remain an Interim Final Reconciliation deadline, while the RAPS PY2017 Final Reconciliation deadline is now May - [Preventing RADV Audit Exposure Through Compliant Risk Documentation Processes](https://paretointel.com/insight/risk-adjustment-data-validation-radv-audit-risk-documentation-compliance/) - Operating a revenue management program in the Medicare Advantage (MA), Affordable Care Act (ACA) and/or Medicaid markets requires a concerted focus and effort on achieving complete, accurate and compliant risk documentation and scores. That third component—compliance—is often overlooked by health plans, at least until faced with a Risk Adjustment Data Validation (RADV) audit. However, various government organizations—including the Centers - [Pareto Intelligence Recognized in Built In Chicago’s Best Places to Work List for 2022](https://paretointel.com/insight/pareto-intelligence-best-places-to-work-2022/) - Pareto Intelligence, a Convey Health Solutions company, has recently been recognized by Built In Chicago as one of the Best Places to Work 2022. Pareto is ranked alongside several other companies in the Chicago tech scene who are chosen by Built In based on employer benefits and employee submitted compensation data. Pareto was also ranked in - [Predicting the Impact of Benefit Design Changes on Enrollment to Drive 2019 Product Strategies](https://paretointel.com/insight/product-elasticity-model-2019-strategies/) - Product strategy planning for 2019 is well-underway for Medicare Advantage Organizations (MAOs) with bid submission deadlines just around the corner. Considering the number of possibilities for product attribute changes and the potential repercussions, it is important for MAOs to proactively understand the impact of changes to premiums, copays, and other pricing strategies on enrollment. Machine - [Power of the Pen: Potential Implications of Trump’s Executive Order on the ACA](https://paretointel.com/insight/implications-trumps-executive-order-aca/) - On October 12, 2017, President Trump signed an executive order initiating significant changes to key provisions of the Affordable Care Act (“ACA”). The Executive Order on its own has no force of law so the coming weeks and months should provide more clarity as the respective federal departments draft new regulations. The key parameters of - [Podcast Interview: Breaking Down Silos in Healthcare with Data](https://paretointel.com/insight/podcast-breaking-down-healthcare-silos/) - Pareto Intelligence's President Jason Montrie was recently interviewed for a popular podcast highlighting innovators in the healthcare industry. Are you familiar with the Pareto Principle? It states that 80% of outcomes come from 20% of the effort. We see this principle at play all over healthcare—in costs, revenue, and employee productivity. The complexity and constant regulatory - [Pareto Intelligence’s Engage Solution Modernizes Health Plan and Provider Communication](https://paretointel.com/insight/pareto-intelligences-engage-solution-modernizes-health-plan-and-provider-communication/) - This innovative messaging solution helped one client achieve a 15% higher condition capture rate in the first six months of a risk documentation improvement campaign and realize $2.7 million in financial improvement to-date. CHICAGO, Ill., November 2018—A leading not-for-profit health plan in the northeast has realized significant improvement in risk documentation completeness from the implementation - [Pareto Intelligence Wins Six Stevie® Awards in the 2020 American Business Awards](https://paretointel.com/insight/pareto-intelligence-wins-2020-american-business-awards/) - Pareto is one of only 17 companies to receive more than five awards, and every entry submitted by the company won an award. CHICAGO, Ill. – August 2020 – Pareto Intelligence (“Pareto”), a healthcare data analytics and technology solutions company and part of the Convey Family of Companies, has received 6 Stevie® Awards across several company- and - [Pareto Intelligence Wins “Best Healthcare Big Data Solution” in 2022 MedTech Breakthrough Awards Program](https://paretointel.com/insight/2022-medtech-awards/) - Pareto Intelligence, a Convey company, has recently been selected as the winner of the “Best Healthcare Big Data Solution” award in the sixth annual MedTech Breakthrough Awards for our Pareto Hub solution! The awards are given by MedTech Breakthrough, an independent market intelligence organization that recognizes the top companies, technologies, and products in the global health and medical technology market. The - [Pareto Intelligence Recognized in Built In Chicago’s Best Places to Work List for 2021](https://paretointel.com/insight/pareto-intelligence-recognized-built-in-chicagos-best-places-work-list-2021/) - Pareto Intelligence (Pareto), a Convey Health Solutions company, has been recognized and ranked by Built In Chicago as one of the 2021 Best Places to Work, Best Small Companies to Work For, and Companies with the Best Benefits. “We are honored to be recognized in Built In Chicago’s Best Places to Work list for the third year in - [Pareto Intelligence Named One of the Top 100 Finalists for the Chicago Innovation Awards](https://paretointel.com/insight/pareto-intelligence-named-one-of-the-top-100-finalists-for-the-chicago-innovation-awards/) - CHICAGO, Ill., October 2018—Out of 519 nominees, Pareto Intelligence has been selected as one of the Top 100 Finalists still in the running for the 17th annual Chicago Innovation Awards. These awards celebrate the most innovative new products and services in the Chicago region across all organization sizes, sectors and industries. 1,500 business and civic leaders will come together to honor - [Pareto Intelligence Introduces Direct-to-EHR Messaging Solution for Enhanced Payer-Provider Communication](https://paretointel.com/insight/pareto-intelligence-introduces-direct-to-ehr-messaging-solution-for-enhanced-payer-provider-communication/) - Pareto Engage modernizes the way health plans and providers communicate by delivering critical member insights directly into Electronic Health Record (EHR) systems and supporting bi-directional communication. CHICAGO, Ill., October 2018—Pareto Intelligence, a leading technology and analytics solutions provider for the healthcare industry, has launched a new solution as part of its Revenue Integrity suite. Pareto - [Pareto Intelligence Honored in Built In Chicago’s Prestigious Best Places to Work List for 2020](https://paretointel.com/insight/pareto-intelligence-2020-best-place-to-work-built-in-chicago/) - Pareto Intelligence has been featured as one of the 2020 “Best Places to Work” and “Best Small Companies to Work for” by Built In Chicago. Companies are selected based on data submitted by companies and their employees. Maria Christopoulos Katris, CEO and Co-Founder of Built In, said, “We extend our heartfelt congratulations to our 2020 honorees. Built - [Pareto Intelligence Combines with Convey Health Solutions](https://paretointel.com/insight/pareto-intelligence-combines-with-convey-health-solutions/) - FORT LAUDERDALE, Fla. & CHICAGO—Convey Health Solutions (“Convey”) today announced an agreement to merge with HealthScape Advisors, LLC(“HealthScape”) and Pareto Intelligence LLC (“Pareto”), combining Convey’s market-leading set of compliant, cost-reducing member enrollment, service, administration, quality and wellness support solutions with HealthScape’s market leading strategic consulting capabilities and Pareto’s innovative suite of big data analytics. The combination of - [Pareto Intelligence Announces Jason Montrie as President](https://paretointel.com/insight/jason-montrie-pareto-intelligence-president/) - Montrie's extensive experience launching and developing a variety of healthcare companies will help take Pareto to the next level, continuing momentum already gained from four consecutive years of growth. CHICAGO, Ill., January 2018—Pareto Intelligence recently welcomed a new addition to its growing team through the appointment of Jason Montrie as President, effective January 16, 2018. Montrie will be - [Pareto Intelligence and HealthScape Advisors to Present at Health Plan Alliance Value Visit](https://paretointel.com/insight/pareto-intelligence-health-plan-alliance-value-visit-2018/) - CHICAGO, August 1, 2018—HealthScape Advisors and its technology and analytics affiliate, Pareto Intelligence, are excited to be attending and presenting at the Health Plan Alliance’s Value Visit on August 6-10, 2018, in San Francisco. The Alliance is a national organization that brings provider-sponsored and independently-owned health plans together with their health system and provider group - [Pareto Intelligence and HealthScape Advisors Achieve HITRUST CSF® Certification](https://paretointel.com/insight/pareto-intelligence-hitrust-certification/) - HITRUST CSF® Certification validates that Pareto Intelligence and HealthScape Advisors are committed to meeting key regulations and protecting sensitive information. Committed to Protecting Sensitive Information Systems that are HITRUST CSF® Certified include our fileshare system, databases, web applications, and supporting infrastructure. To learn more about this announcement, read this article. - [Pareto Intelligence 2021: A Year In Review](https://paretointel.com/insight/insight-pareto-intelligence-2021-a-year-in-review/) - A letter from the President: 2021 was a remarkable year in many ways for Pareto, our employees, and our clients. Our team showed incredible resilience in the face of so many challenges, and we are both proud and lucky to have many new people join us this year. Below is a quick recap of some - [Pareto Intelligence & HealthScape Advisors Named One of the Best Places to Work in Healthcare in 2018](https://paretointel.com/insight/pareto-healthscape-2018-best-places-work-healthcare/) - CHICAGO, Ill., May 2018—Pareto Intelligence (Pareto), through its parent company HealthScape Advisors (HealthScape), has been selected by Modern Healthcare as one of the 2018 Best Places to Work in Healthcare. This award program identifies and recognizes outstanding employers in the healthcare industry nationwide through a robust employer questionnaire and extensive employee survey. Pareto & HealthScape were honored as one - [Pareto Insights: Medicare Advantage Payment Year 2024 Model Update (v28)](https://paretointel.com/insight/medicare-advantage-model-update-v28/) - Summary This month, CMS released the “Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies”. This release included, among other items, major changes to the MA risk adjustment model from risk adjustment MA model v24 to proposed risk adjustment MA model v28. - [Pareto Earns High Marks in KLAS Risk Adjustment Performance Report](https://paretointel.com/insight/klas-risk-adjustment-performance-report-2021/) - The 2021 KLAS Risk Adjustment Performance Report recognized Pareto Intelligence as a Top Performer. Key Findings from KLAS: Pareto’s analytics and proactive partnership lead to high satisfaction; overall MedInsight experience improving EXL’s strong analytics offering expanding to broader capabilities; Advantasure’s technology lacking Apixio’s AI capabilities and client success program drive accuracy, efficiency; Health Fidelity’s difficult implementations causing struggles Pulse8 customers considering leaving due to deteriorating - [PACE 101: Understanding the Medicare/Medicaid Program](https://paretointel.com/insight/pace-medicare-medicaid-program/) - The PACE Medicare/Medicaid Program has quickly become one of the most celebrated health plan models supported by our government. For those who are not familiar, the Program of All-Inclusive Care for the Elderly (PACE) is a fully integrated, provider-based health plan offering comprehensive care to the most frail and costly elderly member population. The PACE - [New Plans on the Block: What to Expect from the MA Competitive Landscape in 2018](https://paretointel.com/insight/medicare-advantage-competitive-landscape-2018-analysis/) - Earlier this month, the Centers for Medicare and Medicaid Services (“CMS”) released the 2018 Medicare Advantage (“MA”) Landscape Files, providing insight into detailed product information for plan benefit packages (“PBPs”) down to the county level. CMS also released PBP Benefits Data, which contains over 50 files of highly specific benefit designs for all services covered - [Navigating the Medicare Advantage Competitive Landscape in 2019](https://paretointel.com/insight/2019-medicare-advantage-competitive-landscape-analysis/) - At the onset of Q4 every year, the Centers for Medicare and Medicaid Services (CMS) gives Medicare Advantage Organizations (MAOs) their first look at what the Medicare Advantage (MA) competitive landscape will look like in the following year in the form of two data releases. The first is the MA Landscape file, which outlines where - [Musings on Health Datapalooza 2018](https://paretointel.com/insight/musings-on-health-datapalooza-2018/) - Last month, five people from Pareto Intelligence attended Health Datapalooza in Washington, DC. Health Datapalooza is an annual gathering of over 1,000 data and technology experts with a focus on exploring ways to improve health for individuals and communities through data. Our employees enjoyed presentations from industry leaders, policy makers, clinicians, researchers, and more in both the - [Explore the 2021 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/explore-the-2021-aca-risk-adjustment-transfer-payment-results/) - On June 30, 2022, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfer for the 2020 Benefit Year, which outlines risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. To help health plans understand the results, Pareto has quickly ingested the data and developed the - [Learn More About Pareto’s Commitment to Collaboration on Built In Chicago](https://paretointel.com/insight/pareto-intelligence-built-in-chicago-collaboration-commitment/) - The best ideas at Pareto come to life through cross-functional collaboration and a diversity of perspectives from all areas of our business—including Engineering and Development, Data Science, Solutions, and more. In the constantly evolving industry of healthcare technology, this collaboration is key to success. Cross-functional Collaboration A recent article by Built In Chicago highlights our collaborative environment - [Jimmy Lee Joins Pareto Intelligence as Strategic Advisor](https://paretointel.com/insight/jimmy-lee-pareto-intelligence-strategic-advisor/) - Jimmy's 30+ year career in healthcare will be critical to advancing Pareto's new and existing analytics solutions to better meet the ever-evolving needs of payers and providers. CHICAGO, Ill., July 2018—Pareto Intelligence is pleased to announce and welcome Jimmy Lee as Strategic Advisor. In this role, Jimmy will draw on his 30+ years of experience to influence - [Improve In-Year Performance by Addressing Encounter Data Quality Issues](https://paretointel.com/insight/improve-2019-performance-encounter-data-quality/) - From encounter to regulatory submission, the flow of health data through various systems and organizations creates many potential areas of data degradation, resulting in data quality issues that negatively impact revenue. These issues can lead to as much as 1%-3% of premium lost due to unreported risk, which requires a holistic effort to identify and - [Improve Data Ownership to Fast-track Your Risk Adjustment Strategy](https://paretointel.com/insight/fast-track-risk-adjustment-strategy/) - Analytics are the foundation for risk adjustment programs. So, how do you gain the critical performance insights you need without a deep understanding of the data? Especially when complete oversight requires a considerable time commitment. True data ownership is often a capacity and subject matter expertise issue, which can be overcome by efficient processes that - [Hidden Figures: 2016 ACA Risk Adjustment Individual Market Results](https://paretointel.com/insight/insight-2016-aca-risk-adjustment-results/) - On June 30, 2017, HHS released the Summary Report on Transitional Reinsurance Payments and Permanent Risk Adjustment Transfers for the 2016 Benefit Year. This report outlines risk adjustment transfers and reinsurance payment amounts by issuer and state. In general, the overarching themes were relatively consistent with prior years. For the 2016 benefit year, risk adjustment - [Heads Up, PBMs: New Reporting Requirements for Prescription Drug Coverage in 2020](https://paretointel.com/insight/section-111-pbms-prescription-drug-reporting-requirement/) - With the recent passage of The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act), major changes are coming to the Section 111 Mandatory Insurer Reporting requirements for Pharmacy Benefit Managers (PBMs). Prior to the implementation of the SUPPORT Act, prescription drug coverage reporting has been voluntary. Starting January - [First Look at the 2020 Medicare Advantage Competitive Landscape](https://paretointel.com/insight/2020-medicare-advantage-competitive-landscape-analysis/) - Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released the 2020 Medicare Advantage (MA) Landscape Files and PBP Benefits Data, providing insight into detailed product information and benefit designs for plan benefit packages (PBPs) down to the county level. With the MA Annual Enrollment Period (AEP) in full swing, plans are seeing the early - [Explore the 2020 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/explore-the-2020-aca-risk-adjustment-transfer-payment-results/) - On June 30, 2021, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfer for the 2020 Benefit Year, which outlines risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. To help health plans understand the results, Pareto has quickly ingested the data and developed the - [Explore the 2019 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/2019-aca-risk-adjustment-transfer-payment-results-analysis/) - On July 17, 2020, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfers for the 2019 Benefit Year, which outlines risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. To help health plans understand the results, Pareto has quickly ingested the data and developed the - [Explore the 2018 ACA Risk Adjustment Transfer Payment Results](https://paretointel.com/insight/2018-aca-risk-adjustment-transfer-payment-results/) - On June 28th, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfers for the 2018 Benefit Year. This report outlines risk adjustment transfers by issuer and state. The interactive dashboards below provide initial insight and allows for year-over-year comparisons into state average metrics, issuer transfer payments, and high-cost - [Encounter Data System (EDS) Submissions for MA Supplemental Benefits](https://paretointel.com/insight/encounter-data-submissions-supplemental-benefits/) - On February 21, 2024, the Center for Medicare and Medicaid Services (CMS) released a notice detailing the requirements for Medicare Advantage (MA) Organizations (MAOs) to submit supplemental benefit encounter data through the Encounter Data Processing System (EDS) beginning with 2024 dates of service. EDS submissions are predominantly managed by risk adjustment programs, either internally or by an - [Deep Dive into Medicare Advantage Supplemental Benefits Trends from 2020 AEP](https://paretointel.com/insight/2020-medicare-advantage-annual-enrollment-period-supplemental-benefits-analysis/) - The health insurance industry has been turned upside down by the COVID-19 crisis. There is much uncertainty surrounding the relief health plans can expect from the government, what has already been announced, and the lasting effects this pandemic will have on your business and members alike. We are in uncharted territory. One of the questions that many - [Convey Health Solutions Names Dan Finke as Chief Executive Officer](https://paretointel.com/insight/convey-health-solutions-names-dan-finke-as-chief-executive-officer/) - Former Aetna President to lead Convey into its next phase of growth FORT LAUDERDALE, Fla., January 29, 2024 /PRNewswire/ -- Convey Health Solutions (Convey), a leading healthcare technology and services company, announced today that it has appointed healthcare executive Dan Finke as Chief Executive Officer. Finke succeeds Stephen Farrell, who has served the company for more than a decade. “I - [Celebrating Women in Tech: An Interview with Pareto’s Female Leaders](https://paretointel.com/insight/women-in-tech-2022/) - At Pareto Intelligence, we are fortunate enough to have some truly amazing women cross all departments and positions. This year for Women’s History Month, we wanted to take a moment to recognize and celebrate the women of Pareto, who without a doubt play an integral role in our success. We recently sat down with four - [CMS Announces an EDS Reporting Extension](https://paretointel.com/insight/cms-announces-eds-submissions-extension/) - On October 20th, the Centers for Medicare and Medicaid Services (“CMS”) informed Medicare Advantage Organizations (“MAOs”) that the encounter data submission deadline has been extended for the second final reconciliation of Payment Year (“PY”) 2016 to April 2, 2018. This allows MAOs to reevaluate their Encounter Data System (“EDS”) submissions and correct any unreported information - [CMS Advanced Notice: Proposed PY2023 Risk Adjustment Updates](https://paretointel.com/insight/cms-advanced-notice-feb-2022/) - On February 2, 2022, CMS released the “2023 Medicare Advantage and Part D Advanced Notice”. In accordance with section 1853(b)(2) of the Social Security Act, CMS is obligated to provide such an announcement that outlines the proposed changes to the Medicare Advantage Risk Adjustment methodology and allows for public comment before final changes are put - [Big Ideas in the Proposed 2021 Notice of Benefit & Payment Parameters for the ACA Market](https://paretointel.com/insight/2021-proposed-aca-notice-benefit-payment-parameters/) - The Department of Health and Human Services (HHS) recently released the Proposed Rule for the 2021 Notice of Benefit and Payment Parameters for the Affordable Care Act (ACA) market (Proposed 2021 Payment Notice). This article provides Pareto Intelligence’s initial summary of key provisions related to the HHS-operated risk adjustment program, as well as our initial perspective - [Avoiding Inaccurate CMS Data Submissions and Supercharging Your Data Process](https://paretointel.com/insight/avoid-inaccurate-cms-data-submisisons/) - $30-$50 PMPY is lost by health plans due to underreported risk in Medicare Advantage (MA) and Affordable Care Act (ACA) markets, according to our recent data analysis. Capturing this lost revenue and achieving end-to-end encounter quality requires complete and accurate data from encounter to submission. A deep understanding of the process’ complex web of systems and - [Attack of the Clones: Using Clone Analysis & Predictive Algorithms to Profile Newly Enrolled Members](https://paretointel.com/insight/clone-analysis-predictive-algorithm-new-members/) - Pareto Intelligence applies advanced predictive analytics to deliver immediate and actionable insights into new member populations. For new ACA member populations in 2017, Pareto: Predicted PLRS within 1% of actual results, enabling more accurate transfer payment accruals. Stratified new members across condition and cost outcomes with over 90% accuracy, prioritizing health plan outreach to proactively engage - [Are You Ready for Increased Use of EDS Submissions in Medicare Advantage Risk Score Calculation?](https://paretointel.com/insight/cms-announces-accelerated-raps-eds-transition/) - On January 6th, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Advance Notice of Methodological Changes for Calendar Year (CY) 2021 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies – Part I, CMS-HCC Risk Adjustment Model. After a preliminary review of the announcement, one significant change stood - [2019 NBPP: It’s About More Than the HCCs](https://paretointel.com/insight/2019-hhs-notice-benefit-payment-parameters-aca-risk-adjustment/) - Recently, the Department of Health and Human Services (HHS) released the 2019 Notice of Benefit and Payment Parameters, which includes the updated risk coefficients for the 2019 Affordable Care Act (ACA) risk adjustment model. HHS acknowledges that significant changes to the risk adjustment model were incorporated in 2017 and 2018, and for 2019, HHS will be calibrating - [2019 Final Call Letter: MA Plans – Don’t Get Lost in the Good News](https://paretointel.com/insight/2019-cms-medicare-advantage-final-call-letter/) - On April 2nd, CMS released the CY 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The primary change grabbing all the headlines is the higher than expected increase to average payments from 1.84 percent in the proposed rule to 3.4 percent. But another important takeaway is CMS confirming the - [2018 Medicare Advantage Annual Enrollment Period Analysis](https://paretointel.com/insight/2018-medicare-advantage-annual-enrollment-period-analysis/) - The data used to populate the 2018 Medicare Advantage Annual Enrollment Period (AEP) Analysis was automatically aggregated using the Pareto Spotlight solution, using the final AEP results data released by CMS on February 15, 2018. Pareto Spotlight Current Pareto Spotlight subscribers can use this link to log in and pull further insights from the 2018 Medicare Advantage - [2018 ACA Risk Adjustment Transfer Payment Results: “Premium Stabilization Program” Beginning to Stabilize](https://paretointel.com/insight/2018-aca-risk-adjustment-transfer-payment-results-detailed-analysis/) - On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days of the announcement, Pareto published a preliminary analysis highlighting major trends and year-over-year comparisons into state average metrics, issuer transfer payments, and high-cost risk pool - [2017 Risk Adjustment Transfer Payment Results: Same Game, Different Outcomes](https://paretointel.com/insight/2017-risk-adjustment-transfer-payment-results-analysis/) - Year-over-year gross transfer dollars increased 2% nationally across the Individual and Small Group risk pools but range from -99% to 1000+% across state markets. On July 9th, 2018, the Centers for Medicare and Medicaid Services (CMS) released the Affordable Care Act (ACA) Risk Adjustment Transfer Payment results for the 2017 benefit year. Litigation in New - [The Latest CMS Ruling: What This Means for Medicare Advantage Organizations](https://paretointel.com/insight/cms-ruling-2023/) - On January 30, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized a new rule to overhaul risk adjustment audits performed on Medicare Advantage plans. This ruling directly impacts CMS’ Risk Adjustment Data Validation program, which focuses on the substantiation of diagnostic information submitted for risk adjustment consideration. While CMS has performed several variations of RADV ## Success Stories - [Improving Value-Based Reimbursement Through RevenueIQ Analytics](https://paretointel.com/success-story/success-story-value-based-reimbursement/) - A health system used Pareto Intelligence analytics to identify revenue leakage tied to risk documentation and encounter data quality, improving value-based reimbursement accuracy. - [Blue Cross of Idaho & Pareto Intelligence to Present Innovative Approach to Provider Communication at RISE National](https://paretointel.com/success-story/blue-cross-idaho-pareto-intelligence-provider-communication-strategy/) - Have you ever found yourself wondering, “how do we solve the asymmetry of patient information between health plans and providers?” If yes, you’re not alone. Innovative Approach to Provider Communication Blue Cross of Idaho, a leading insurer in Idaho with approximately 550,000 members across the Commercial, Medicare Advantage (MA) and Affordable Care Act (ACA) markets, found - [Value-Based Reimbursement](https://paretointel.com/success-story/value-based-reimbursement/) - Value-Based Reimbursement Success Story THE SITUATION A large health system in the Midwest engaged Pareto Intelligence in an evaluation of the completeness and accuracy of encounter data for their Medicare Advantage (MA) delegated risk population, limited to members from only one of their health plan partners. Because most encounter submission processes exist within health plan - [Quis cumque sint in aut doloremque nemo](https://paretointel.com/success-story/quis-cumque-sint-in-aut-doloremque-nemo/) - Repudiandae et non ut temporibus quasi quis Libero ad Neque qui eaque ratione In id sunt voluptatem aut Rem repudiandae et cumque praesentium Aspernatur nam qui Quisquam optio harum repudiandae nisi Dignissimos quaerat Ea est rerum necessitatibus consequatur. Placeat harum officia vero suscipit. Dignissimos magnam quibusdam hic porro natus Earum Ut ab eligendi omnis est - [Est rem ut rerum ut](https://paretointel.com/success-story/est-rem-ut-rerum-ut/) - Voluptas est quasi qui quaerat. Enim assumenda qui tenetur odit incidunt Quo ea animi commodi ut illo quidem rerum. Reiciendis ad non quia non voluptatem nobis et. Et sit laboriosam alias eos Sit et impedit at doloreTemporeAutem aperiam nihil etQuae neque harum debitis Dolores enim atque laudantium adipisci fugit quo incidunt. Aut dolores omnis autem - [Et distinctio quia accusantium](https://paretointel.com/success-story/et-distinctio-quia-accusantium/) - Omnis et accusantium aliquid. Molestiae expedita nisi perspiciatis praesentium quam alias rem. Velit et magnam porro ut Voluptas consectetur dolore eveniet explicabo Et odit qui ut est voluptatem Porro qui sint molestiae eveniet et. Suscipit sunt odit omnis odio deserunt. Ipsum ullam unde sequi. Quod libero nesciunt debitis eligendi. nemo consequatur aperiam in. Laboriosam nesciunt ## Webinars - [Beyond the Noise: Insights on the 2026 CMS Star Ratings](https://paretointel.com/webinar/beyond-the-noise-live-insights-on-the-2026-cms-star-ratings/) - Explore CMS Star Ratings trends, measure-level performance, and strategic insights for Medicare Advantage plans in this on-demand webinar with industry experts. - [Unlocking Success: Best Practices for Monitoring Health Plan Data Submissions to CMS](https://paretointel.com/webinar/unlocking-success-best-practices-for-monitoring-healthplan-data-submissions-to-cms/) - Discover how under-reported risk in MA and ACA markets affects your revenue. Watch to learn about improving encounter data quality and operational efficiency. - [How to Accelerate Your Risk Adjustment Strategy](https://paretointel.com/webinar/how-to-accelerate-your-risk-adjustment-strategy/) - Unlock insights into risk adjustment data with Pareto RevenueIQ to enhance transparency and allow for data-driven strategies. Watch our on-demand webinar to learn how. ## Categories - [Insights](https://paretointel.com/category/insights/) ## Categories - [Tool](https://paretointel.com/cus-category/tool/) - [Success Story](https://paretointel.com/cus-category/success-story/) - [Report](https://paretointel.com/cus-category/report/) - [Insight](https://paretointel.com/cus-category/insight/)