Operator playbooks for value-based care.
Practical, numbers-first guides for risk-bearing healthcare leaders. Written by the Pelica Health team for the people who run the work, not the people who watch the dashboards.
V28 Risk Adjustment Readiness: A 90-Day Playbook for Risk Teams
CMS's V28 HCC model finishes its phase-in in 2026. The all-in effect is roughly a 3% to 4% RAF compression for the average MA plan. A practical 90-day plan for closing that gap.
Read the guide →PDC Math: Why 5 Points Separates 4-Star from 2-Star
The three triple-weighted Part D adherence measures move Stars more than any other lever. The math, the cliff effect, and the operational changes that actually shift PDC.
Read the guide →Building a RADV-Defensible HCC Capture Program from Scratch
The 2023 RADV rule made findings extrapolated and the FFS adjuster gone. Seven design choices that turn an HCC capture program into one that survives audit.
Read the guide →The ECDS Transition: What Changes When Hybrid HEDIS Retires
NCQA retires hybrid HEDIS by reporting year 2029. Supplemental data volumes increase 35x to 75x per measure. What the data infrastructure has to look like to survive the shift.
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