Markets
Two markets that are not the same market.
We work across the United States, starting in Florida, and in Puerto Rico. Puerto Rico carries Medicare Advantage, Medicaid and commercial risk exactly as the mainland does, and behaves like none of it. We build for that difference rather than translating around it.
Beginning in Florida. Not limited to it.
Florida is where our first mainland engagements sit, and it is a reasonable place for a firm like ours to start: dense Medicare Advantage penetration, a large independent physician base, and active consolidation among practice groups. The methodology is not specific to the state, and neither is the practice.
Groups carrying more than one contract
Multi-site practices, and the associations they contract through, where gap closure and condition accuracy are revenue rather than reporting. Also fee-for-service groups, who carry none of that and still need to know whether the practice is running well.
Operators accountable for practices they do not own
You run the administrative and operating side for practices that stay clinically independent, on different systems and under different contracts. Establishing where each one actually stands is most of the job.
Groups acquiring practices
Buyers who need an evidenced operating picture of a practice before the purchase, and the same view every month after it.
The island is not a mainland market with a different address.
The usual approach is to take a product built for the mainland, translate the interface and call the market served. That fails for reasons that have nothing to do with translation. The funding mechanics, the benchmarks, the panel economics and the documentation practice are all different, so a method calibrated on mainland inputs returns a confident answer that is wrong.
Managed care is the market, not a segment of it
Puerto Rico runs 86.7% Medicare Advantage penetration against a national figure of 51.1%, the highest of any state or territory. Traditional fee-for-service is the exception on the island, not the default. Assumptions built for a market where roughly half of Medicare beneficiaries sit in Medicare Advantage do not survive contact with one where nearly nine in ten do.
Measured. Medicare Advantage and other health plan share of Medicare beneficiaries, April 2026. Puerto Rico 86.7%, national average 51.1%. Compiled from CMS monthly enrollment by state data.
Medicaid is a capped allotment, not an open-ended match
Puerto Rico receives a fixed annual federal allotment with a statutory matching rate, rather than the uncapped federal match the fifty states receive. Roughly 1.3 million people are covered, and every one of them is in managed care. When the cap binds, the adjustment falls on the delivery system rather than on the federal share.
Measured. Medicaid and CHIP enrollment of 1.3 million as of January 2026, Medicaid.gov Puerto Rico state overview. Financing structure per the Consolidated Appropriations Act, 2023.
There is a funding date on the calendar
The current allotment and the 76% matching rate run through the end of federal fiscal year 2027. Absent congressional action, the allotment reverts to a formula based on a much older baseline and the matching rate falls to 55% in fiscal 2028. Every provider organization on the island is operating against that date, whether or not their vendors are.
Measured, current law and time-sensitive. Puerto Rico federal Medicaid allotments and FMAP through FY2027 per the Consolidated Appropriations Act, 2023, as summarized by KFF. Post 2027 treatment reflects current law absent further legislation.
The benchmarks were built somewhere else
Medicare Advantage benchmarks derive from local fee-for-service costs, and the island's fee-for-service population is small enough that the inputs behave differently than they do in a state. Quality rating methods carry the same inheritance. This has been the subject of published research and sustained advocacy for years, and it is a live commercial fact for anyone measured by those instruments.
Characterization of a documented policy dispute, not a Caredatum finding. See the peer reviewed literature on Medicare Advantage financing and quality in Puerto Rico, and the advocacy record of the Puerto Rico Medicare and Medicaid Advantage Products Association.
The work happens in Spanish
Clinical documentation, member outreach and the conversation in the exam room are conducted in Spanish. A finding that the person responsible for acting on it cannot read is not a finding, it is a translation problem you have paid for. This is a design constraint on the deliverable, not a localization task at the end of one.
Capacity is the binding constraint
Sustained physician emigration has made provider supply, not member identification, the limiting factor across much of the island. That is precisely why operations sits inside our instrument rather than in a separate report. On the island, the question of whether there is an appointment to close the gap in is frequently the whole question.
Continuity breaks, and the data shows it
Storm seasons interrupt care delivery and the encounter data that records it. A measure that looks open may be an encounter that was delivered and never posted. A method that cannot tell those apart will misstate a provider's performance and then hold them to it.
Truescore is calibrated per market, not ported to it.
The four dimensions and the evidence standard hold everywhere. What changes between markets is the reference data underneath them, and pretending otherwise is how a method quietly stops being accurate.
Reference populations
Comparison is made against the market the practice actually operates in. An island panel benchmarked against mainland norms produces a number that is precise and meaningless.
Language of the deliverable
The provider page and the working lists are produced in the language the practice works in, as a first class output rather than an export.
Operating assumptions
Access, panel size and capacity models are set to local supply conditions, which is what makes the operations dimension informative rather than decorative.
Where we have not calibrated, we say so
If we have not yet established a reference for a market, a line of business or a measure, the finding is marked as uncalibrated rather than published with borrowed inputs. That will happen, and you will see it when it does.
Why we lead with this
Providers and plans on the island have spent years being sold mainland products with a Spanish interface, by firms that treated a genuinely different market as a distribution problem. We are not better at Puerto Rico because we say the word. We are useful there because the differences above are inputs to the method rather than caveats at the end of a deck.
Next step
Start with a baseline.
If you have been sold a mainland product with a translated interface before, the reasonable response to this page is skepticism. The baseline is how that gets settled: run it on your own panel, against your own market, and see whether the reference data underneath it is yours or somebody else's.
Give us one period of data from the contracts you already hold. We return your position across all four dimensions, the evidence behind every finding, and the specific work that would move it. You decide what happens after that, not before.