How to Build a Defensible API-First Analytics Stack for Medicare Advantage Payers

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A technical guide published on DEV Community outlines how software engineers can design value-based care analytics platforms for Medicare Advantage plans as a structured engineering problem rather than ad hoc reporting. The approach centers on strict data contracts for encounter ingestion, deterministic Risk Adjustment Factor (RAF) scoring using the CMS-HCC V28 model, and full auditability built into the API layer. Engineers are advised to use a dedicated scoring API to handle HCC hierarchy logic server-side, avoiding score inflation from manually summing raw weights. Suspected conditions should carry structured evidence fields — such as lab values, prescriptions, and prior diagnoses — to support defensibility during CMS audits. The guide emphasizes that a versioned, clean API is the durable foundation, with dashboards treated only as a presentation layer on top.

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