As payers back new rules on home visits and diagnosis-driven payments, the industry is shifting from documentation to real care delivery. Here’s what it means—and how to stay ahead.

A quiet but powerful shift is underway in Medicare Advantage—and it’s about to change how health plans are paid.

Just hours after senators added MA overpayment reform to their legislative priorities, Humana publicly called for eliminating payments tied to diagnoses from home-based risk assessments (HRAs) unless they’re confirmed in other settings. UnitedHealth Group followed suit, backing policies that would require timely follow-up care, care navigation, transparent reporting, and annual audits.

This isn’t speculation. This is the largest realignment of MA risk adjustment in over a decade—and it’s already happening.

Why this matters now

For years, certain risk-scoring practices relied on disconnected chart reviews and at-home assessments with no clinical follow-up. A federal watchdog report found $7.5 billion in risk-adjusted payments went to MA plans based solely on diagnoses from chart reviews—no tests, no visits, no care.

Now, with Congress, CMS, and the industry’s largest players aligned on reform, the old model of “code now, confirm later” is being replaced with a new mandate:

Prove that care actually happened.

The Challenge

Most payers already understand what needs to change:

Diagnoses must be clinically validated. Follow-up care can’t be optional. Risk adjustment must reflect actual patient impact—not just documentation.

The real issue? Doing all of this efficiently, at scale, without creating chaos for your teams.

How Kbrax Helps You Act on Reform

That’s where Kbrax comes in.

We built our platform for this exact moment—helping health plans transition smoothly from outdated HRA workflows to modern, compliance-ready models that regulators and providers can trust.

With Kbrax, you get:

- Diagnosis validation tied to real medical encounters

-Automated follow-up care workflows to close the loop after HRAs

-Audit-grade visibility into every step of the risk journey

-Built-in safeguards to avoid over-coding, upcoding, and chart-only risk scoring

Whether you’re tightening compliance or rethinking your risk strategy entirely, Kbrax simplifies the transition—so you can focus on outcomes, not damage control.

Don’t wait for reform to be mandated. It’s already moving.

Plans that wait will be left retrofitting their systems under pressure. Plans that prepare now can lead—and build lasting trust with regulators, providers, and members alike.

Kbrax is here to help you lead that change.

Let’s stop using HRAs to check a box.

Let’s start using them to deliver care that counts.