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AI Governance, Audit Readiness, and the Defensibility Standard in Value-Based Care

Webinar

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CMS audit scrutiny reached a new threshold in 2026, with Payment Year 2020 RADV audits active across approximately 550 Medicare Advantage contracts and annual audits on a quarterly cadence now announced for all eligible organizations. Every organization in Reveleer's 2026 national research study reported universal AI deployment, yet only 13% of health plans describe themselves as well-prepared for current CMS audit conditions. The organizations absorbing the most financial exposure share a common profile defined by governance investment that did not keep pace with deployment, data quality infrastructure deprioritized in favor of capability acquisition, and documentation practices built in response to audit rather than before it.

This panel draws on The Defensibility Standard: The State of Technology in Value-Based Care 2026, a report by Mathematica based on a national survey of 200 senior payer and provider leaders conducted by The Harris Poll. Jay Ackerman, CEO of Reveleer, Ngan MacDonald, Director of the Data Innovation Lab at Mathematica, and Vindya Dayananda, EVP of Corporate Strategy and Development at Reveleer, bring distinct perspectives on AI governance gaps, vendor rationalization, and the operational decisions distinguishing plans that can defend their risk scores under active CMS audit conditions.

 

Topics at a Glance

  • AI governance commitment and the gap between deployment and audit defensibility.

  • AI vendor consolidation and how procurement criteria moved from feature capability to integration depth and regulatory alignment.

  • The operational profile of health plans well-prepared for current CMS audit conditions.

  • Data quality investment priorities and the upstream consequences for RAF accuracy.

  • Technology investment and governance decisions heading into the next CMS audit cycle.

 

Who Should Attend

  • VPs and Directors of Risk Adjustment

  • Chief Medical Officers and Medical Directors

  • Chief Financial Officers and revenue cycle leaders managing Medicare Advantage exposure

  • Compliance and Government Programs leaders overseeing CMS audit readiness obligations

  • VPs of Technology and Data responsible for AI governance and vendor strategy

 

Top Reasons to Attend

  • Review findings from a Harris Poll survey of 200 payer and provider leaders, analyzed by Mathematica on a vendor-neutral basis, on AI governance, data confidence, and CMS regulatory preparedness.

  • Quantify the governance gap between universal AI deployment and declining organizational commitment, and its direct implications for RADV audit posture.

  • Benchmark your organization against the operational profile shared by health plans producing defensible risk adjustment results under active CMS audit conditions.

  • Trace how data quality investment declined relative to security spending and where that reallocation introduced downstream RAF and documentation risk.

  • Leave with a framework for applying 2026 research findings to technology investment and governance decisions ahead of the next CMS audit cycle.

Speakers

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