HIT Consultant January 19, 2026
The RADV expansion isn’t the real story. Neither is V28.
The real story is what happened when both arrived simultaneously—and exposed a truth the industry had been quietly ignoring: the AI that powered risk adjustment for the past decade was never built for the precision, explainability, or adaptability the new environment demands.
Traditional NLP succeeded because the tolerance for error was high enough to absorb its limitations. That tolerance just evaporated.
The 70% Accuracy Nobody Questioned
For years, the industry accepted a peculiar compromise: AI that got it right 70-75% of the time out of the box, maybe 85-90% after months of training. This is because the systems relied on statistical pattern-matching rather than clinical reasoning. The tools identified words...
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