Medicare Advantage Risk Adjustment
Expert articles and analysis related to medicare advantage risk adjustment.
AI Summary â Last 30 Days
In the past 30 days, significant advancements in value-based care (VBC) models have emerged, particularly with the launch of new initiatives like the Medicare Shared Savings Program (MSSP) and the Transforming Episode Accountability Model (TEAM) by CMS, aimed at enhancing care quality and reducing costs. Notably, the Community Care Cooperative (C3) recently reported earning over $10 million in shared savings through the MSSP, reinforcing the potential for ACOs to drive financial efficiency in care delivery. Meanwhile, CMS's upcoming LEAD model looks set to further refine ACO structures by directly linking quality performance with financial outcomes, emphasizing a strategic pivot towards outcome-oriented payment methodologies in value-based care systems. The introduction of these models underscores the evolving landscape where financial accountability and the quality of care become integral to the operational strategies for health systems.
Related Articles
CMS receives record comments on controversial Medicare Advantage payment proposal
The Trump administration wants to keep MA rates flat next year and change how risk adjustment is calculated. Insurers had a lot to say about this, CMS officials shared Tuesday during an event in D.C.
CMS threatens Elevance with Medicare Advantage sanctions
Federal regulators are planning to suspend enrollment in Elevance's MA plans at the end of March, in a rare and serious threat to the companyâs finances.
Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment - MedPAC (.gov)
Considerations for implementing Medicare Advantage encounter data in risk adjustment  MedPAC (.gov)
The Value Shift â How Medicare Advantage Benefits Are Evolving for 2026
This updated paper builds on Wakelyâs prior analysis of Medicare Advantage benefit design, incorporating newly released 2026 enrollment data to provide a clearer picture of how market dynamics are evo...
Which types of health insurers make the most money?
It turns out the answer is Medicare Advantage plans according to a KFF analysis released today. However the reason why Medicare Advantage is more profitable may not be obvious: At the end of 2024, gro...
Medicare Advantage Policies, ABNs, and QIO
Letâs start with what seems to be a never-ending topic of conversation: the new policies by Medicare Advantage (MA) plans to deny or reduce payments for inpatient admissions. Last week Independence Bl...
Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network
Clover Health Moves from Pledge to Production, Becomes The First Payer Live on a CMS Aligned Network  Clover Health
More
About 280,000 older adults experience the âMedicare Cliffâ each year, becoming eligible for Medicare and losing Medicaid coverage when they turn age 65 years due to discontinuities in financial eligib...
Costs loom amid evolving trans care policies
Hospitals urged CMS to withdraw proposed rules aimed at barring âsex-rejecting proceduresâ on children, while others warned of costs. Several hospital groups raised objections to two proposed rules fr...