For Payers, Medicare Advantage & Insurers

Stop losing RAF to MCI you’re not catching.

Acurist’s 97.3%-accurate MCI Screen identifies members 3+ years earlier than MMSE — with audit-grade documentation that defends HCC coding through RADV, and Star/HEDIS uplift through provider-led AWV capture.

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Why Early Detection Matters for Payers
MCI prevalence in 65+ populationUp to 42%
Members unaware they have MCI~60%
Annual progression rate (untreated)15% per year
Seniors receiving regular cognitive assessmentOnly 16%
MCI Screen accuracy97.3%
LTC placement reductionStar/HEDIS upliftTotal cost of careAWV captureCCM enrollment
V24 → V28CMS is fully transitioned and cutting MA risk scores by an average of ~3.12%. Plans that detect and stage cognitive impairment under the new HCC 125–127 hierarchy protect their RAF — plans that can’t leak it.
Why This Matters Now

Undetected cognitive impairment is a quiet, addressable driver of plan cost and lost revenue.

LTC

Long-term care is the single largest avoidable cost.

Delaying institutionalization by months produces immediate, auditable savings for plans.

ER

Acute spikes around diagnosis drive short-term budget volatility.

Early detection reduces ER visits and hospital admissions through medication reconciliation and targeted care.

RAF

Risk adjustment and quality incentives are material and auditable.

Accurate, documented diagnoses increase RAF revenue and support Star/HEDIS improvements — revenue that pays for the program and then some.

The Precision Staging Imperative

Turn a coding threat into an audit-proof revenue engine.

Under V28, plans can no longer rely on volume or catch-all “unspecified” diagnostic codes. Success requires a shift from simple diagnosis to high-precision severity staging — and nowhere is the financial delta starker than in cognitive impairment.

HCC 127
Mild / Unspecified

Where most plans get stuck. Generic dementia codes leave legitimate funding on the table.

HCC 126
Moderate

Audit-defensible staging unlocks up to ~$3,300+ in incremental annual revenue per properly identified member.

HCC 125
Severe

Late-stage capture. Costlier care, but compliant documentation when supported by objective measurement.

Failing to detect cognitive decline captures $0 in risk-adjustment revenue while exposing the plan to reactive, late-stage medical cost. Passive coding practices also face a 2–4% baseline capitation erosion under V28.

What Acurist Delivers for Payers

A complete cognitive health solution built for plan economics, Star Rating, and HEDIS scores improvements — not just a screening tool.

🎯

Validated early detection at scale

Automated screening plus high-accuracy clinical confirmation so you find the right members without overwhelming providers.

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Actionable care pathways

Standardized Individual Care Plans (ICP) and chronic care management (CCM) workflows that reduce falls, medication errors, and avoidable admissions.

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Audit-grade documentation

Registry, timestamps, and clinician notes that defend HCC coding and RADV audits — protecting RAF revenue.

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Claims-ready measurement

Pre-agreed adjudication rules (TOB/POS/revenue centers, MDS, facility days) and a reconciliation workbook that produces provisional quarterly statements and a final annual settlement.

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Provider-friendly

Acurist cognitive health solutions are designed for easy implementation by care providers — no specialist credentials required to administer, no IT lift, and a clinician report ready before the provider walks in the room.

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Operational simplicity

Turnkey provider billing templates (CPT 99483, AWV integration), care manager playbooks, and a lightweight data exchange using hashed IDs.

Typical Payer Outcomes

What you can expect, measured over a 12-month attribution window.

Every outcome is reconciled against claims and validated by your actuarial team.

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Fewer LTC placements & days

Per confirmed cohort, measured over a 12-month attribution window.

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Lower hospital & ER utilization

Among confirmed members through proactive management and medication review.

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Incremental RAF / HCC revenue

From earlier, defensible coding of cognitive impairment.

Star & HEDIS improvement

Higher cognitive assessment and care-plan rates translate to plan revenue upside.

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Clear, auditable ROI

Low upfront PMPM and milestone costs; shared savings paid only on validated avoided spend.

The Acurist V28 Bridge

Your compliance & revenue bridge under V28.

Acurist solves the structural payer dilemma with an integrated, end-to-end platform — transforming cognitive care from a liability into a high-margin asset.

Frictionless enterprise scaling

Native integration into Epic and Athena as standard order sets. Providers leverage rapid, automated billing templates (CPT 99483, Medicare AWV) — turning a clinical hurdle into a reimbursed, self-funding care protocol.

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Bulletproof audit defense

Validated Memory Screen and MCI Screen deliver >90% clinical accuracy. Paired with automated FAST tracking, Acurist drops time-stamped, objective data straight into the EMR — documentation that withstands aggressive CMS RADV audits.

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Closed-loop margin protection

V28 funding is only profitable if it isn’t consumed by reactive crisis utilization. Acurist auto-generates Personalized Risk Profiles and Individual Care Plans — delaying nursing-home placement and reducing catastrophic hospitalizations from chronic-disease mismanagement.

Compounding Returns

The financial & operational compounding effect.

Standardized early cognitive screening creates returns that compound across an entire senior-population book.

Aggressive ROI
~$69.7M

net savings across a 3-year maturity curve for a 10,000-senior population — approximately $139 in long-term cost avoidance for every $1 invested in the Acurist framework.

Quality Bonus
+5% QBP

Documented cognitive assessment and care planning map directly to HEDIS Care for Older Adults and Dementia Management & Support metrics. Crossing the 4-star benchmark unlocks the Quality Bonus Payment.

D-SNP Opportunity
High-acuity duals

Dual-Eligible SNP populations are highly susceptible to under-documented cognitive disease. Acurist provides the documentation to support integrated benchmarks — while the clinical support reduces member churn.

Per Confirmed Member
~$3,300+

incremental annual revenue when a member moves from “unspecified” to an audit-defensible HCC 126 (Moderate Dementia) — backed by objective testing and FAST staging.

Figures are directional and vary by population size, plan mix, baseline screening rate, and contracting model. Actual outcomes are reconciled against claims data over the attribution window.

Interactive ROI Model

Model your plan’s V28 payor ROI.

Enter your covered senior population and see the projected annual value of accurate cognitive staging — V28 RAF capture, Star quality bonus, delayed institutional care, and reduced acute utilization — modeled the way our actuarial team builds a payor engagement.

Your plan

Start with three inputs. Open the assumptions panel below to model a specific scenario.

Adjust clinical assumptions
15%
92%
50%
6 mo
15%

Illustrative projection based on the Acurist payor actuarial model and CMS-HCC V28 parameters. Results depend on plan mix, baseline utilization, regional cost, and contract structure, and are not a guarantee of outcomes or a pricing proposal. A claims-linked analysis is available for your specific population.

Projected annual impact — at steady state
$80.5M
Net Annual Value
68.1×
Value per $1 Invested
3,450
Members Accurately Staged
$81.7M
Total Value Created

Get the full breakdown

See every value driver, the cohort funnel, and the 3-year pro forma. We’ll email the detailed payor report to you.

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No spam. Your figures are sent to the Acurist actuarial team so we can follow up with a tailored, claims-linked analysis.

Ready to Evaluate a Pilot?

Schedule a 30-minute introductory meeting.

We’ll run a quick feasibility scan using your age-band counts and historical LTC placement rates — and show a pilot ROI scenario tailored to your population.

Custom feasibility scan and tailored ROI scenario · HIPAA compliant · No commitment

Detect MCI earlier. Stage dementia accurately.
Prevent costly institutional care.

Capture RAF and Star value with auditable, claims-based reconciliation.

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