Proposed MA Risk Adjustment Model – Good News for Some, Detrimental for Others

On February 1, 2023, CMS released the 2024 Advance Notice, which details planned changes to the Part C and Part D capitation and risk adjustment methodology for calendar year (CY) 2024. As part of the Advance Notice, CMS is proposing to implement a revised version of the CMS-HCC risk adjustment model for the aged/disabled population. CMS estimated the new risk score model would drive an average impact of -3.12% to MA plan revenue in 2024. The actual revenue impact is expected to vary considerably across MA plans and risk-bearing providers. This paper dives into the drivers of the wide variation in MA plan and risk-bearing provider specific results.

Proposed MA Risk Adjustment Model - Good News for Some, Detrimental for Others

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