RISE 2023

Our experts will be available to discuss priority topics, such as:

Impacts of the RADV Final Rule: The Centers for Medicare & Medicaid Services (CMS) released the final MA risk-adjustment data validation (RADV) rule on January 30. The final rule sets future RADV policy and creates uncertainty for MA plans. Avalere is well positioned to provide industry perspectives on the final rule and to help plans mitigate risks posed by RADV audits and operational challenges posed by the rule.

Advance Notice Policies: On February 1, CMS released the 2024 MA and Part D Advance Notice. Plans are required to submit comments by March 6, 2023. The proposed changes have major implications to MA plan payment and long-term strategy. Our policy and health plan operations experts support clients in navigating these policy changes to maximize quality and reimbursement in MA and Part D.

Inflation Reduction Act (IRA) Implications: Avalere’s experts can help clients understand how implementation of the IRA is impacting payment rates, plan bids, and beneficiary out-of-pocket costs, and forecast the likely impact on formulary negotiations.