As CMS prepares to issue its final Rate Announcement for Medicare Advantage (MA) and Part D, the Advance Notice continues to draw record-breaking public engagement. While the projected 0.09% net average year-over-year payment increase for MA plans has insurers worried it won’t keep up with rising medical costs, one proposed update to the CMS-HCC risk adjustment model caught our attention, in particular: the requirement that all diagnoses are linked to a medical encounter. To put it another way, unlinked chart review records will no longer be taken into account for risk scores.
With this shift, demonstrating clinical value becomes even more critical.
In his article, “CMS Is Ending the Risk Adjustment Arbitrage Era (Here’s What That Means for Your Health Plan Deals),” author Ryan Peterson adeptly captured the heart of the proposed changes: “CMS is systematically unwinding the economics that rewarded coding sophistication and replacing them with economics that reward clinical value delivery.”
If you’ve been in the healthcare industry awhile, you know the tide has been turning towards value-based care for quite some time. With the “silver tsunami”–the rapid aging of the population as baby boomers hit retirement age–putting increased pressure on healthcare, CMS’s Advance Notice underscores the importance and urgency of continuing to make the shift to value-based care. With this shift, demonstrating clinical value becomes even more critical.
How is clinical value demonstrated?
1) Documented encounters and
2) Chart retrieval.
In short, providers need to document what they actually address in face-to-face encounters, and health plans need to get as complete of a clinical record as possible for its members in order to maximize payments. While there are other solutions focused on helping providers document as accurately and comprehensively as possible at the point of care, Moxe excels in the chart retrieval space. We’ve been laser focused on automating the secure exchange of clinical data for more than a decade, and our Chart Retrieval solution is well positioned to support health plans in their efforts to demonstrate clinical value.
Using our proprietary and ever growing 150M+ member network of large national health plans, regional health plans, enterprise EHR connections, national health data networks, and third-party requestors, our Chart Retrieval solution quickly aggregates patient records across disparate networks. We deliver high-quality, discrete data when and how it’s needed, streamlining the secure exchange of clinical data. Our solution overcomes the inefficiency of health plans not having direct access to various EHRs, which historically has required staff to call or fax doctors’ offices for records–a slow, labor-intensive process that causes friction with providers. When they work with Moxe, health plans get direct, secure connectivity to providers and access to the high quality clinical data they need.
In a time where there is no shortage of clinical data, it is important that your data exchange strategy is as comprehensive, and scalable, as possible.
Moxe works with our payers to establish direct provider connections to automate clinical data exchange for payment and operations use cases. As health systems merge and acquire smaller hospitals with perhaps different EHRs, how will your clinical data acquisition strategy scale?
For providers using Epic, Oracle, and MEDITECH, Moxe establishes a 100% digital connection to the EHR as part of our proprietary provider network. Additionally, we have established enterprise EHR connections to Greenway Health and athenahealth to deliver data at scale from these often hard-to-reach practices. When you partner with Moxe for an enterprise EHR connection, you receive access to the network of Greenway providers, for example, without having to establish point-to-point connections or manually chasing those charts.
Moxe is the one connection you need to access clinical data at scale, covering various EHRs. We then take it one step further to deliver that data in your desired format (CCDA, FHIR, PDF), making it immediately actionable.
With CMS’s proposed updates for 2027, it becomes even more essential that health plans receive accurate, comprehensive clinical data in a timely manner so they can identify any missing information and contact clinicians to ensure they capture necessary diagnoses. Health plans can no longer rely on retrospective chart review; they need to efficiently retrieve and act on clinical data.
Moxe was recently named #1 Best in KLAS for Payer-Provider Data Exchange 2026. This award shines a light on how our trusted framework is delivering tangible outcomes, with 95% of our customers saying they would buy Moxe again. It’s an honor to partner with our customers, who share our belief that there is a better way to exchange clinical data.
We’d love to answer your questions on our Chart Retrieval product and discuss how we might help you navigate the changes coming in 2027 and beyond.