3 Problems Facing Medicare Advantage Providers Today

There’s no denying the enormous opportunity available to Medicare Advantage providers. Nearly 32 million members are currently enrolled in MA plans, and more than 10,000 patients become eligible for Medicare every single day.

But MA providers also face significant challenges that make it harder for them to remain compliant and deliver the highest quality of care. 

In this article, we’ll examine three of the most pressing issues for MA providers today, along with possible strategies for minimizing them. 

1. Limited Access to Patient Medical Histories 

Did you know that the average MA patient's medical history contains more than 40 documents and hundreds (or even thousands) of pages? 

In one test with a provider group in New Jersey, a records request for 270 patients returned more than 31,000 records. 

When you also consider the fact that more than half of the text in these documents is duplicated from past records (learn more about the “note bloat” conundrum here), it’s easy to understand why providers often walk into patient encounters with little to no understanding of their medical histories. 

2. Heavy Reliance on Manual Processes 

Unless we embrace automated, digital solutions for reading and summarizing medical records, MA providers will never be able to keep up with the volume of data they’re receiving.

At Credo, we’ve developed our first-of-its-kind product, PreDx to quickly and accurately gather and analyze all available patient records, providing a comprehensive summary providers can read before walking into the patient encounter. 

This allows them to spend less time playing catch-up and duplicating services that have already been completed, and more time delivering high-quality care. 

3. Risk Adjustment Challenges Create Administrative Burdens 

Without a streamlined process for gathering and analyzing medical records, the transition to CMS-HCC V28 is placing an additional burden on MA providers. 

Not only do they have to learn a reorganized set of HCCs, but they also have to document diagnoses more accurately than ever before in order to minimize revenue corrections under the new model.

MA providers need a solution that will allow them to make this transition with ease, so they can spend less time on paperwork and more time focusing on patient care.

To learn more about how we're supporting organizations through the transition to V28, download our free guide: 

Purple text on light blue background, next to a picture of a smiling Asian male doctor: "Your Comprehensive Guide to Navigating V28. Download Here"

Your Medicare Advantage Partner for Risk Adjustment, Care Improvement, and More

MA organizations need a strong partner and a workflow that makes providers' lives easier, instead of harder.

That’s where Credo comes in. 

When you partner with Credo on your medical record retrieval and analysis, you can expect to see a significant increase in RAF, and a direct improvement in the quality of care your providers are equipped to deliver. 

To learn more about partnering with Credo, or joining our pilot to test out PreDx for free, schedule a demo today.

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