SERVICES
Five practice areas.
One integrated performance model.
IQRP's services are designed around the five levers that determine financial performance in Medicare Advantage: quality recognition, documentation integrity, risk capture, predictive analytics, and utilization control. Each can be engaged independently — or as a unified program.
PRACTICE AREA 01
Quality Recognition & Stars Performance
In Medicare Advantage, Stars ratings are not just a quality scorecard — they are a direct revenue mechanism. A one-star improvement can mean tens of millions in quality bonus payments. IQRP builds the programs, workflows, and governance systems that move the needle systematically.
HEDIS measure performance optimization and gap closure prioritization
Medicare Advantage STARS program design and ongoing management
CAHPS patient experience strategy and score improvement
Clinical quality measure (CQM) reporting for CMS programs
Quality committee governance design and facilitation
Provider-level performance reporting and accountability frameworks
Population stratification and care gap prioritization by financial impact
Outreach and intervention workflow design for systematic gap closure
MIPS performance programs for participating providers
PRACTICE AREA 02
Clinical Documentation Integrity
Documentation accuracy is the foundation of both risk recognition and quality reporting. Incomplete or imprecise encounter data directly reduces risk scores, fails quality measures, and creates audit exposure. IQRP builds the structured documentation systems that make accuracy systematic — not dependent on individual provider behavior.
Encounter integrity framework design and implementation
MEAT documentation standards and provider education programs
CPT II code optimization and integration into clinical workflows
Supplemental data program design for MA risk adjustment
EHR workflow optimization for structured, consistent data capture
Documentation audits and corrective action planning
Appeals documentation frameworks to reduce reversal exposure
Prior authorization documentation alignment
PRACTICE AREA 03
Risk Recognition & RAF Optimization
In Medicare Advantage, your Risk Adjustment Factor score is your revenue per member. Undercoded populations leave money on the table; imprecise coding creates RADV audit exposure. IQRP delivers prospective and retrospective programs that improve HCC capture, RAF accuracy, and coding defensibility — simultaneously.
Prospective risk adjustment program design and management
HCC coding accuracy assessments and gap identification
Retrospective chart review and reconciliation programs
RAF score analysis and per-member opportunity quantification
CMS Risk Adjustment Data Validation (RADV) preparation
Coding compliance audits and corrective action planning
Condition prevalence benchmarking against attributed population
Provider coder training and quality assurance program design
D-SNP, PACE, and behavioral health risk recognition optimization
PRACTICE AREA 04
Predictive Analytics & Intelligence
Integrated performance requires knowing where to act before problems compound into losses. IQRP's analytics infrastructure — built on integrated claims, clinical, and encounter data — gives MA executives the PMPM intelligence, risk forecasting, and quality dashboards needed to make decisions with precision rather than retrospective awareness.
PMPM forecasting and financial impact modeling
RAF score projection and trajectory analysis
Stars measure prediction and gap prioritization analytics
Utilization trend modeling and high-cost outlier identification
Cohort-level risk segmentation and care-management triggers
Population health data platform design and implementation
Claims, clinical, and ADT data integration
FHIR-based interoperability and real-time data exchange
HIPAA-compliant data infrastructure and security architecture
PRACTICE AREA 05
Utilization Control & Payer–Provider Alignment
In a cost environment growing at 8% annually, utilization management is not a back-office function — it is a core financial lever. IQRP redesigns UM workflows, aligns prior authorization processes, and builds the payer–provider performance governance that creates real accountability across the care network.
Utilization management workflow redesign and optimization
Prior authorization process alignment and efficiency improvement
High-cost utilization outlier identification and intervention
Interdisciplinary care team design for high-acuity populations
Transitional care and avoidable readmission reduction programs
Provider-level performance dashboards and accountability frameworks
Network performance analytics and adequacy optimization
Delegated risk group performance governance and oversight
CMS 2026 Final Rule compliance alignment for UM and prior authorization
GET STARTED
Not sure where your biggest opportunity is?
Most IQRP engagements begin with a performance assessment — a structured review of your organization's quality, documentation, and risk position that quantifies where the largest financial opportunities exist.