Episode 30: Navigating the shift to prospective risk adjustment with hybrid AI

In this 20-minute episode of RISE Radio, Editorial Director Ilene MacDonald sits down with Dr. Matt Lambert, the former chief medical officer at Reveleer, to unpack the rapidly evolving landscape of Medicare Advantage risk adjustment. Together, they discuss the implications of the 2027 Advance Notice, new OIG compliance guidance, and the industry’s shift toward encounter-based, prospective risk adjustment. Dr. Lambert explains how hybrid AI—combining generative AI with long‑standing clinical rules—can improve accuracy, reduce false positives, and streamline workflows for providers, payers, and risk adjustment teams. He also shares practical strategies for organizations beginning this transition, emphasizing partnership, user‑friendly workflows, and technology that meets clinicians at the point of care. About Matt Lambert, M.D. Dr. Matt Lambert , is the former chief medical officer at Reveleer and a leader in health care innovation, blending clinical expertise with technology, policy, and payment strategies. He previously served as CMO of Curation Health (acquired by Reveleer in 2024) and led digital transformation at Clinovations and The Advisory Board. He has been CMIO for New York City Health + Hospitals, RWJ Barnabas, and Johns Hopkins, overseeing Epic and Cerner implementations. An emergency medicine physician for 20+ years, he authored two books on health care reform. He earned his MD from Marshall University and trained at West Virginia University. About Reveleer Reveleer, a health care software and services company, uses machine learning and intelligent automation technology to empower health plans control over their quality improvement, risk adjustment, and member management programs. With one transformative solution, Reveleer allows plans to independently execute and manage provider outreach and data retrieval, coding, abstraction, member management, and reporting. Reveleer leverages proprietary technology, robust data sets, and subject matter expertise, so health plans can execute programs that deliver value and improved outcomes. Click here for Reveleer’s Guide to AI in Value-Based Care.

You can listen to Episode 30: Navigating the shift to prospective risk adjustment with hybrid AI online on Radio and Podcast. Open the player on this page to stream the available audio.

Episode 30: Navigating the shift to prospective risk adjustment with hybrid AI is an episode from RISE Radio by Ilene MacDonald.

This episode is 20:11 long.

This episode was published on Feb 13, 2026.

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