Transitioning to V28 of CMS’ HCC model: No time like the present

Why it’s important to transition to the new model now and how you can make the transition as seamless as possible.

 On March 31, the Centers for Medicare & Medicaid Services (CMS) announced the gradual transition to version 28 (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 be planning for this transition. In this article, I'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 three percent to eight percent. 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 percent, while the new V28 model holds a 33 percent share. This balance undergoes a substantial shift in 2024, with 67 percent of the weight now assigned to the V28 model and only 33 percent to the V24 model. By 2025, the transition is complete, with the V28 model taking center stage at 100 percent.

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 leads to better patient care planning and improved health outcomes.

How you can begin transitioning

Whether you’ve already started transitioning to V28 or haven’t begun the process yet, it’s important that you leverage a flexible analytics tool that can adapt to these new changes. Here are four key features you should expect from your analytics technology:

1. Comprehensive V28 model analysis: Your tool should provide a detailed analysis of how the V28 model impacts your organization. These insights should be actionable, empowering strategic decision-making and risk adjustment optimization.
2. Seamless transition: Your analytics platform should be user-friendly and simplify the transition process, ensuring minimal disruption to your current operations and a smooth shift to the blended model.
3. Revenue optimization: Your analytics tool should maximize revenue capture under the V28 model, aligning your financial strategies for peak profitability.
4. Proactive risk adjustment: Your technology should enable prospectively planned care programs by analyzing risk scores and RAF opportunities, allowing for more precise member demographics and timely interventions.

The V28 model marks a significant change that necessitates early and seamless adoption. Health plans that transition early not only ensure compliance and gain a competitive advantage, but also improve patient outcomes. It’s time to find a strategic partner that will help you navigate this transition and master the V28 model successfully.

About the Author

Vijaya Vishwanathan is the director of product for Episource.

Vishwanathan leads the organization’s risk adjustment and analytics platform by leveraging technology and data to provide insights and segmentation into health care data, helping manage interventions efficiently, and thereby providing better patient care. She brings in-depth knowledge of Medicare Advantage, Medicaid, and other programs from her experience with health plans in various functions.