The "guessing game" is officially over. On April 2, 2026, the Office of Inspector General (OIG) released a series of audits targeting high-risk diagnosis codes within Medicare Advantage (MA) plans, specifically naming Priority Health and Gateway Health Plan. The findings were a wake-up call for the industry: an estimated 9.5% of all Medicare Advantage payments are improper, largely due to a lack of medical record support for submitted codes. At CareVelocity Advisory, we see t

The End of Administrative Debt: Why the 'FHIR-ification' of HEDIS is a Structural Mandate In the traditional landscape of healthcare quality reporting, there has always been a persistent, costly friction point: the gap between clinical care and administrative compliance. We call this Administrative Debt. It’s the accumulation of manual chart pulls, retroactive data cleaning, and fragmented workflows that occur when quality reporting is treated as an after-the-thought exercise

Healthcare today faces a paradox. There is no shortage of data. Every interaction, test, and treatment generates countless data points. Yet, patients and providers alike experience friction because these data points rarely connect. This disconnect creates what many call Administrative Debt —extra work, inefficiencies, and gaps in care that burden healthcare organizations and frustrate patients. At the heart of every successful value-based care (VBC) model lies the Integrated

Healthcare startups are reshaping the industry with incredible innovation — from AI-driven clinical tools to new care delivery models. But after more than two decades working inside healthcare organizations, one pattern continues to emerge: Most healthcare startups don’t struggle because of weak ideas or technology. They struggle because the healthcare system operates on a very different set of rules. In my experience, the three biggest opportunities for healthcare startups t

Healthcare organizations don’t suffer from a lack of strategy. They suffer from misalignment. Across boardrooms and executive teams, strategy decks are polished. Quality initiatives are defined. Value-based contracts are signed. Risk adjustment programs are funded. KPIs are tracked. And yet performance stalls. Stars plateau. Documentation gaps persist. Audit exposure increases. Provider engagement fluctuates. Revenue opportunity leaks quietly through operational friction. The

In the ever-evolving landscape of healthcare, complexity often reigns supreme. From intricate patient needs to multifaceted regulatory requirements, the challenge lies in transforming this complexity into measurable results that enhance patient care and operational efficiency. This blog post will explore how healthcare organizations can navigate this complexity, implement effective strategies, and ultimately achieve tangible outcomes.

In the ever-evolving landscape of healthcare, the pursuit of quality is paramount. As healthcare providers strive to deliver better patient outcomes, the concept of strategic alignment emerges as a crucial factor. This blog post explores how aligning organizational goals, resources, and processes can significantly enhance the quality of healthcare services.

The healthcare industry is undergoing a significant transformation, driven by technological advancements, changing patient expectations, and evolving regulatory landscapes. As healthcare providers strive to enhance patient care while maintaining financial viability, understanding the key drivers of revenue growth becomes essential. This blog post explores actionable insights that can help healthcare organizations thrive in a competitive environment.