- The Centers for Medicare and Medicaid Services’ switch from the Hierarchical Condition Categories model V24 to the modernized V28 brings about an updated disease classification structure that aligns with current healthcare standards.
- V28 enhances the accuracy of Medicare Advantage payments, impacting conditions like diabetes and dementia.
- Under the new model, HCC categories rise from 86 to 115, with updated inclusion and exclusion criteria.
- The transition aligns closely with Adageis’s mission of revolutionizing patient care through innovative value-based care solutions, positioning the company for growth.
- Adageis aims to improve healthcare delivery by helping providers streamline operations and focus on delivering quality care by implementing its AI-centric ProActive Care Platform.
- A unique offering in the healthcare technology space, the ProActive Care Platform offers flexible integration, proactive efficiency and advanced predictive analysis capabilities.
Adageis is a forward-thinking healthcare technology company reshaping patient care through flexible AI-centric software solutions for healthcare systems and providers. The company is in support of the Centers for Medicare and Medicaid Services’ (“CMS”) switching from the V24 to the V28 upgrade of the Hierarchical Condition Categories (“HCC”) model, considering the increased accuracy it will bring to Medicare Advantage payments and its overall improved alignment with current healthcare standards.
The shift to V28 is being phased in over three years, as this gradual timeline offers healthcare providers and Medicare Advantage plans the opportunity to adapt to the details of the new system:
- 2024: V24 accounts for 67% of risk scoring; V28, 33%.
- 2025: V24 drops to 33%; V28 rises to 67%.
- 2026: Full adoption of V28.
The transition from CMS-HCC V24 to V28 reflects a critical update to the risk adjustment model used in Medicare Advantage. By moving to ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) coding, the Centers for Medicare and Medicaid Services align risk adjustment with the modern healthcare system, which adopted ICD-10 in 2015.
The more precise structure enhances diagnostic specificity, allowing for better patient categorization. This change supports value-based care by tying payments more closely to actual patient needs.
Key differences between V24 and V28 include:
- Expanded categories: HCC categories grow from 86 to 115, offering a more granular view of patient risk.
- Fewer codes: The total number of HCC codes decreases from 9,797 to 7,770, with 268 new diagnosis codes mapped.
- Condition focus: Conditions like diabetes see reduced risk scores, while dementia gains improved detection capabilities through expanded categories.
By recalibrating using more recent data—2018 diagnosis and 2019 fee-for-service (“FFS”) expenditure data—the model reflects current healthcare realities more accurately than the older V24, which relied on 2014 and 2015 data.
For the broader healthcare ecosystem, the update represents a step toward greater precision and fairness in Medicare Advantage payments. Removing certain conditions from the model, such as some cardiovascular and musculoskeletal conditions, reduces the potential for overpayments. Meanwhile, the expanded focus on underdiagnosed conditions like dementia ensures that patients with complex needs receive adequate support.
The CMS-HCC transition aligns closely with Adageis’s mission of revolutionizing patient care through innovative value-based care solutions. The company’s ProActive Care Platform leverages AI-driven predictive analytics to optimize care and reimbursement, making it uniquely suited to help healthcare providers navigate these changes.
By integrating seamlessly with existing electronic medical records (“EMRs”) and reducing the barriers to adoption, Adageis empowers organizations to meet the challenges of the V28 model. The platform’s ability to identify high-risk patients and streamline care planning is crucial as providers adjust to new risk-scoring dynamics.
Additionally, the platform’s design eliminates the need for costly infrastructure upgrades or extensive staff training, reducing adoption barriers and enabling organizations to thrive in today’s complex healthcare environment. The platform is easily scalable, with various packages available to meet users’ needs.
The ProActive Care Platform also supports patient-centered care while optimizing reimbursements linked to quality metrics and value-based contracts. Key features include:
- Predictive Analytics: AI-driven insights identify high-risk patients and care gaps, enabling providers to improve outcomes and manage costs effectively.
- Proactive Efficiency: Monitors patient health continuously, allowing for timely interventions beyond traditional office visits, improving care efficiency and reducing expenses.
- Flexible Integration: Compatible with leading EMR systems such as AthenaHealth, Cerner, eClinicalWorks, Allscripts, and Epic, ensuring smooth implementation without disrupting workflows or requiring extensive training.
The adoption of V28 is seen as an opportunity for Adageis to demonstrate the value of advanced technology in delivering cost-effective, high-quality care, enabling the company to leverage its unique offering to drive meaningful change in the evolving global healthcare AI market.
For more information, visit the company’s website at www.Adageis.com.
NOTE TO INVESTORS: The latest news and updates relating to Adageis are available in the company’s newsroom at https://ibn.fm/Adageis
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