Case Study: Regional Medicare Advantage Blue Plan achieves a simplified, higher-ROI risk adjustment process with Ciox Health

A Regional Blue Plan Optimized End-toend Risk Adjustment Process

Regional Medicare Advantage Blue Plan turned to Ciox Health after struggling with high overhead, multiple vendor hand-offs, and quality issues across its risk adjustment analytics, retrieval, and coding processes. The fragmented setup created coordination burdens and made it difficult to meet performance targets for yield, quality, and timeliness.

Ciox Health implemented an end-to-end risk adjustment solution that combined analytics, chart retrieval, and coding services, supported by proprietary algorithms, provider retrieval knowledge, and dedicated account management. The result was a simplified risk adjustment experience with fewer hand-offs, higher program return on investment, lower risk adjustment spend, improved retrieval yield, and reduced provider abrasion.