Wedemeyer Consulting LLC delivers specialized risk adjustment and healthcare quality improvement consulting services to health insurance plans. Leveraging deep clinical expertise in risk adjustment models and HEDIS metrics, we help health plans improve quality performance, optimize reimbursement accuracy, and achieve better healthcare outcomes — with precision, integrity, and measurable results.
Santa Clarita, CA 91350 · (661) 306-3492
Health insurance plans operate in an increasingly complex regulatory and reimbursement environment. Inaccurate risk adjustment coding, underperforming HEDIS measures, and missed quality benchmarks translate directly into lost revenue and reduced star ratings — outcomes no plan can afford.
Wedemeyer Consulting LLC exists to close that gap. We bring the clinical and analytical expertise your team needs to navigate risk adjustment models, close care gaps, and drive sustainable quality improvement.
Ensure your risk scores reflect the true clinical complexity of your membership.
Elevate HEDIS and Star Ratings metrics with targeted, evidence-based strategies.
Align clinical and operational efforts to deliver measurable member health improvements.
Wedemeyer Consulting LLC provides expert guidance on CMS-HCC, HHS-HCC, and CDPS risk adjustment models. We help health plans identify documentation gaps, improve coding accuracy, and ensure compliant, complete risk score submissions that reflect the true clinical burden of your population.
We partner with health plans to analyze HEDIS performance data, identify care gaps, and implement targeted interventions. Our strategies are grounded in clinical evidence and designed to produce sustainable, auditable improvements across key quality measures.
From program design to execution, we help plans build robust quality improvement infrastructures. This includes developing workflows, training clinical staff, and establishing performance monitoring systems aligned with NCQA and CMS standards.
Medicare Advantage Star Ratings directly impact plan revenue and member retention. We provide strategic consulting to help plans understand their current performance, prioritize high-impact measures, and implement evidence-based interventions to improve their overall Star Rating.
Accurate clinical documentation is the foundation of compliant risk adjustment. We work with plan partners and provider networks to improve documentation practices, ensuring that member diagnoses are captured completely, accurately, and in accordance with CMS guidelines.
Navigating CMS Risk Adjustment Data Validation (RADV) audits and other regulatory reviews requires specialized expertise. Wedemeyer Consulting LLC provides audit preparation, response support, and ongoing compliance monitoring to protect your plan from financial and regulatory risk.
Specialized knowledge of risk adjustment models (CMS-HCC, HHS-HCC, CDPS) and HEDIS metrics — not generalist consulting.
We help plans capture every compliant dollar they are entitled to — no more, no less.
Our strategies are designed to improve real member health outcomes, not just move metrics on paper.
Every recommendation is grounded in current CMS and NCQA guidelines — accuracy and compliance are non-negotiable.
As a boutique consulting firm, we provide direct, senior-level attention to every client engagement — no hand-offs to junior staff.
Clear deliverables, measurable milestones, and honest performance reporting at every stage of the engagement.
Locally rooted, nationally capable — serving health plans across California and beyond.
Risk adjustment and quality improvement are among the highest-ROI investments a health plan can make. For Medicare Advantage plans, a single Star Rating improvement can translate into hundreds of millions of dollars in Quality Bonus Payments (QBPs) — and improved risk score accuracy directly impacts per-member-per-month (PMPM) revenue.
For ACA Marketplace plans, accurate HHS-HCC risk scores ensure that reimbursement reflects the true cost of your membership, protecting plan financial stability in a competitive market.
Wedemeyer Consulting LLC helps plans capture these opportunities compliantly and sustainably. We recommend that clients confirm current CMS payment parameters and program specifics with their compliance and actuarial teams, as rates and methodologies are updated annually.
MA plans seeking to improve CMS-HCC risk scores, elevate Star Ratings, and maximize Quality Bonus Payment eligibility through compliant, evidence-based strategies.
Marketplace insurers looking to optimize HHS-HCC risk adjustment submissions, improve HEDIS performance, and strengthen their competitive position in the individual and small group markets.
Medicaid MCOs navigating state-specific risk adjustment methodologies and quality improvement requirements, seeking expert support to improve performance and member outcomes.
Risk adjustment is the process by which CMS and state regulators account for the health status of a plan's membership when calculating payments. Accurate risk adjustment ensures your plan is reimbursed fairly for the clinical complexity of your members. Wedemeyer Consulting LLC helps plans identify documentation gaps, improve coding accuracy, and submit compliant risk data — protecting revenue and ensuring regulatory compliance.
We begin with a detailed analysis of your current HEDIS performance data to identify your lowest-performing measures and the root causes of underperformance. We then design and support targeted interventions — including care gap closure programs, provider outreach strategies, and member engagement initiatives — to drive sustainable, auditable improvements.
Yes. While we are based in Santa Clarita, CA, we provide consulting services to health plans nationally. Our work is primarily analytical and advisory in nature, making remote engagement highly effective for most clients.
A Risk Adjustment Data Validation (RADV) audit is a CMS review process that validates the accuracy of a Medicare Advantage plan's risk adjustment data submissions. An adverse RADV finding can result in significant payment recoveries. Wedemeyer Consulting LLC provides pre-audit preparation, documentation review, and response support to help plans navigate RADV audits successfully.
Simply call us at (661) 306-3492 or email david@wedemeyerconsulting.net to schedule your complimentary assessment. We will review your plan's current risk adjustment and quality performance data and identify your highest-priority opportunities — at no cost and with no obligation.
As a specialized boutique firm, every engagement is led directly by David Wedemeyer, bringing senior-level clinical and analytical expertise to your specific challenges. You will never be handed off to a junior consultant or receive generic recommendations. Our focus is narrow, deep, and results-oriented.
Wedemeyer Consulting LLC is ready to help your health plan improve risk adjustment accuracy, elevate quality performance, and achieve better outcomes for your members. Contact us today to schedule your Free Assessment — no cost, no obligation.
Santa Clarita, CA 91350
(661) 306-3492
david@wedemeyerconsulting.net
Take the first step toward optimized reimbursement accuracy, stronger quality scores, and better member outcomes. Our team is ready to assess your plan's current performance and identify your highest-impact opportunities.
Wedemeyer Consulting LLC
Scientific & Technical Consulting Services in Santa Clarita, CA