For Medicare Advantage (MA) risk adjustment leaders, the second half of the year often feels like a balancing act. Teams are working against submission deadlines, monitoring performance, and closing documentation gaps, all while preparing for the changes that will shape next year's strategy. Leaders must ensure today's decisions position the organization for success in the future.
The months ahead require leaders to focus on both execution and preparation. That means understanding where performance stands today, addressing operational bottlenecks before deadlines arrive, strengthening provider and member engagement, and building the processes needed to navigate evolving audit requirements and coding changes. The objective is not to choose between financial performance and compliance, but to improve risk-score accuracy, revenue integrity, and audit defensibility together.
Explore the priorities that matter most as 2026 enters its final stretch and highlights strategies that can help MA organizations finish strong while building a more accurate, encounter-linked, and continuously controlled program for 2027.
Achieving program targets
The second half of the year is when performance gaps become impossible to ignore.
By this point, leaders have enough data to see whether chart retrieval, coding production, and documentation efforts are tracking toward annual goals. Evaluating whether a vendor or internal team’s actual output aligns with the established plan—and assessing the level of confidence in their ability to close any gaps—distinguishes successful programs from those that encounter shortfalls too late to course-correct.
When challenges emerge, such as slowing retrieval rates, growing coding backlogs, or underperforming chase lists, organizations need to identify the root cause quickly and determine where intervention will have the greatest impact. This may involve a targeted analytics push, focused chase-list and retrieval activity, or additional coding capacity.
Having a connected view of retrieval, coding, and submission activities can make a significant difference. Integrating these activities into a unified workflow with comprehensive dashboards enables leaders to direct resources more effectively, prioritize opportunities based on clinical relevance, documentation risk, likelihood of closure, and potential financial impact, and keep programs moving toward their targets.
Meeting tighter deadlines
As submission deadlines approach, every day matters. Risk adjustment teams are working to ensure diagnoses are accurately captured, coded, validated, and submitted before regulatory cutoffs. Delays anywhere along the process, whether in provider documentation, chart retrieval, coding review, or encounter submission, can affect risk-score accuracy, payment accuracy, and revenue integrity.
The pressure extends beyond submissions themselves. Data reconciliation, quality checks, and error resolution become increasingly urgent as the calendar winds down. A rejected encounter or unsupported diagnosis often requires rapid investigation, correction, and resubmission. Connecting medical record coding outputs with encounter management, reconciliation, and submission workflows can simplify complex processes while maintaining a focus on accuracy.
Closing provider and member gaps
Success in risk adjustment still starts with strong payer-provider collaboration. Provider engagement can improve documentation accuracy and help ensure that conditions evaluated and addressed during qualifying encounters are represented appropriately. During the second half of the year, many plans increase targeted education, outreach, and documentation review while preserving the provider's responsibility for the final diagnosis and coding decision.
At the same time, member engagement becomes increasingly important and increasingly difficult. Schedules become busier, outreach fatigue sets in, and appointments become harder to secure as the year draws to a close.
To maximize results, organizations should use actionable data to coordinate clinically appropriate member and provider outreach. Bringing risk and quality intelligence together can help plans identify opportunities that may be addressed through the same encounter, reduce duplicative contacts, and create a more streamlined experience.
Strengthen your approach to audit readiness. Our Building Audit-Ready Risk Adjustment Programs eBook explores strategies that help health plans proactively address compliance risks, support accurate documentation and coding, and maintain readiness throughout the risk adjustment lifecycle.
Learn how a comprehensive, year-round approach can help reduce risk exposure and build a stronger foundation for program performance
