Uploaded August 2026 | Updated September 2026, 2 weeks ago
Health plans are facing growing pressure to improve Medicare Advantage risk-adjustment accuracy while reducing the cost and provider burden associated with retrospective chart retrieval.
In this eSolutions Exchange webinar, InterSystems experts Steven Berkow and Julie Smith explain how health plans can use existing clinical data, including Continuity of Care Documents (CCDAs) from provider connections, payer platforms, health information exchanges, and data aggregators, to modernize risk-adjustment workflows and improve RADV audit readiness.
Learn how a clinical-data-first approach can help plans:
• Reduce unnecessary medical-record requests and provider abrasion
• Find documentation supporting submitted diagnoses
• Identify documented conditions that may support appropriate supplemental submissions
• Use human-governed AI to connect diagnoses with clinical evidence
• Improve traceability, governance, and audit readiness
• Extend the value of clinical data across quality, care-gap closure, care management, and member engagement
The speakers also discuss why AI must not function as a black box. Recommendations should be explainable, traceable to the original clinical source, and validated by qualified human reviewers.
Featured speakers:
Steven Berkow
Head of Value-Based Care Market Strategy, InterSystems
Julie Smith
Head of Global Healthcare Market Strategy, InterSystems
Chapters:
00:00 Welcome and introductions
01:33 Why traditional chart chasing is becoming unsustainable
05:38 Risk adjustment, RAF scores, and documentation requirements
09:38 How RADV audits are changing
15:07 Using CCDAs for risk adjustment
18:04 Traditional versus clinical-data-first workflows
24:56 Applying human-governed AI
30:09 Implementation and governance questions
37:32 Where health plans should begin
41:12 Closing remarks
Health plans are facing growing pressure to improve Medicare Advantage risk-adjustment accuracy while reducing the cost and provider burden associated with retrospective chart retrieval.
In this eSolutions Exchange webinar, InterSystems experts Steven Berkow and Julie Smith explain how health plans can use existing clinical data, including Continuity of Care Documents (CCDAs) from provider connections, payer platforms, health information exchanges, and data aggregators, to modernize risk-adjustment workflows and improve RADV audit readiness.
Learn how a clinical-data-first approach can help plans:
• Reduce unnecessary medical-record requests and provider abrasion
• Find documentation supporting submitted diagnoses
• Identify documented conditions that may support appropriate supplemental submissions
• Use human-governed AI to connect diagnoses with clinical evidence
• Improve traceability, governance, and audit readiness
• Extend the value of clinical data across quality, care-gap closure, care management, and member engagement
The speakers also discuss why AI must not function as a black box. Recommendations should be explainable, traceable to the original clinical source, and validated by qualified human reviewers.
Featured speakers:
Steven Berkow
Head of Value-Based Care Market Strategy, InterSystems
Julie Smith
Head of Global Healthcare Market Strategy, InterSystems
Chapters:
00:00 Welcome and introductions
01:33 Why traditional chart chasing is becoming unsustainable
05:38 Risk adjustment, RAF scores, and documentation requirements
09:38 How RADV audits are changing
15:07 Using CCDAs for risk adjustment
18:04 Traditional versus clinical-data-first workflows
24:56 Applying human-governed AI
30:09 Implementation and governance questions
37:32 Where health plans should begin
41:12 Closing remarks
