Healthcare Risk Management
Support built for HMOs, MSOs, and IPAs.
Beyond equipment, Maintenance Matrix manages risk and growth for Medicare members and physicians — working directly with your marketing team on outreach, and with your physicians on the reporting that keeps revenue and compliance accurate. We can also help contract new physicians in the areas your organization needs.
Growth & member outreach
Membership growth and retention
We work with your marketing department on strategies for membership growth and retention, and encourage physicians to be part of that outreach directly.
- PCP welcome outreach to new members, including provider logos and photos
- Collaboration on welcome letters and materials with your marketing team
- Community events, such as church partnerships and open house mailings
- Call center campaigns for newly enrolled, dis-enrolled, or non-compliant members
- Support for member outreach initiatives that close gaps in non-compliant measures
- Coordination with health plans on PCP-related growth initiatives
Medical management & reporting
Records review physicians can rely on
We personally review monthly medical management reports with physicians, overseeing medical records review to maximize accuracy in risk adjustment (RAF / MRA).
- HEDIS and encounter audits and reconciliation
- Claims reconciliation and review of capitated claim encounters
- Incentive program (HRA) tracking
- Reconciliation of refund requests
- Credentialing paperwork facilitation for new and existing providers
- ER utilization and hospital census tracking
- Care management and Rx utilization reporting
- Specialist utilization tracking
- Decision-support tools to help PCPs capture open measures during a visit
- Reconciliation of claims data to PCP-submitted claims and records
- Monthly chart audits and membership trend tracking by PCP group
- Recommendations on PCP panel status — open, closed, or terminated
Terms explained
A quick glossary
Healthcare risk management comes with its own vocabulary. Here's what the terms on this page mean in plain language.
- RAF
- Risk Adjustment Factor — a score reflecting how sick a health plan's members are on average, used to determine reimbursement.
- MRA
- Medicare Risk Adjustment — the CMS methodology that applies risk scoring specifically to Medicare Advantage and related plans.
- HEDIS
- Healthcare Effectiveness Data and Information Set — a standardized set of measures used to evaluate quality of care across health plans.
- Star Ratings
- CMS's 1-to-5-star quality rating system for Medicare Advantage and Part D plans, which affects both reputation and reimbursement.
- IPA
- Independent Physician Association — a group of independent physicians who contract together, often to negotiate with health plans and share administrative resources.
- MSO
- Management Services Organization — an entity that provides administrative and operational support to physician practices or groups.
FAQ
Healthcare risk management
What's the difference between an HMO, MSO, and IPA?
An HMO manages member care through a network of providers. An MSO provides administrative and management support to physician groups. An IPA is a group of independent physicians who contract together, often to negotiate with health plans and share administrative resources. Maintenance Matrix works with all three.
What are RAF and MRA, and why do they matter for revenue?
RAF and MRA are scoring systems that determine how much a health plan is reimbursed based on the documented health status of its members. Inaccurate or incomplete documentation understates a member's risk, which understates the plan's revenue — accurate medical records review directly protects that revenue.
Do you work directly with physicians?
Yes. We collaborate with physicians on monthly medical management reporting, credentialing paperwork, and outreach materials like PCP welcome letters, working alongside your marketing department throughout.
What kind of reporting do we receive?
Monthly reporting covering HEDIS and encounter audits, claims reconciliation, ER utilization, hospital census, care management, Rx and specialist utilization, and membership trends by PCP group, among other measures relevant to your plan.