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When a Matrix comprehensive health assessment (CHA) identifies a member need, 45% of those members see their PCP within 60 days and 77% within 90 days¹. That kind of follow-through has always mattered—and, it’s about to matter a lot more.

Beginning in 2027, CMS will exclude “unlinked” chart review diagnoses from Medicare Advantage risk adjustment.  In other words, conditions will only count toward risk adjustment if they can be connected to a clinical service. This new policy doesn’t just tighten documentation rules. It draws a hard line between plans that can prove a member’s need led to real care, versus plans that can only prove that a member need was observed and written down. Putting plans on the right side of the line is where CHAs earn their value.

Most Care Models Aren’t Built For Follow-through

Because MA risk adjustment has long rewarded plans for finding conditions at scale, even when there was no record of what happened next, most existing care models are built only to spot needs, not to prove follow-through. Outreach lists, referrals and gap flags are common outputs. But once a need is logged, many programs have limited visibility into whether that member issue was ever resolved. Was the member scheduled? Seen? Was the encounter connected back to the original diagnosis in a way that would satisfy a reviewer?

For most plans, honest answers include “it depends,” and “it’s hard to prove either way.” It’s a longstanding operational gap—one that now has a financial and audit consequence, thanks to CMS’s policy update.

How Matrix CHAs Close the Loop

In contrast, Matrix CHAs are structured to ensure observed member needs connect to documentable actions. There are two keys to this:

• The visit itself is the clinical encounter. Every diagnosis captured during an in-home CHA is already tied to a documented clinical service — the assessment itself — giving it a natural, defensible link that unlinked chart reviews can’t offer.
• After-visit steps are reported.  When a CHA surfaces a need, Matrix tracks the next step whether it’s a PCP follow-up, care management engagement, or condition-specific support. That reporting gives its partners the same thing CMS is now requiring: visible, trackable proof that an identified need turned into delivered care.