Risk Adjustment & Benchmarking
Expert articles and analysis related to risk adjustment & benchmarking.
AI Summary — Last 7 Days
Risk adjustment and benchmarking debates sharpened this week around Medicare Advantage and managed care: MedPAC’s defense of its $76B MA overpayment estimate intensified the fight between plans, policymakers, and researchers over coding intensity, encounter-data validity, and whether MA benchmarks are paying for value or selection/coding advantages. In Medicaid, implementation of the 2025 reconciliation law is creating managed care rate-setting uncertainty and potential plan exits, raising near-term risk for states, MCOs, and provider-led VBC arrangements that depend on actuarially sound capitation, stable attribution, and predictable quality/risk corridors. Together, the week’s developments point to a more contested pricing environment in which ACOs, MA plans, Medicaid MCOs, and health systems will face tighter scrutiny of benchmarks, risk scores, and whether payment models are rewarding true population-health performance versus documentation and market leverage.
Related Articles
MedPAC Chair Defends $76 Billion Medicare Advantage Overpayment Estimate as Insurers Push Congress to Change the Math
MedPAC Chair Defends $76 Billion Medicare Advantage Overpayment Estimate as Insurers Push Congress to Change the Math  Medical Daily
Implementation of 2025 Reconciliation Law: Medicaid Managed Care Rate Setting Uncertainty & Potential Plan Exits
This policy watch examines recent and anticipated managed care rate setting challenges and the potential implications of MCO exits.
The Inverted Circuit: Attribution, Answerability, and Accountability in Canadian Health Governance
The Inverted Circuit: Attribution, Answerability, and Accountability in Canadian Health Governance  Milbank Memorial Fund
Medicare Advantage: What Are We Paying For?
Medicare Advantage: What Are We Paying For?  Health Affairs
Reimagining Value-Based Deals Through Risk-Pooling Models
CY 2027 Medicare Physician Fee Schedule Proposed Rule Could Reduce Average Reimbursement by 2.2%
Wakely’s analysis examines how proposed CY 2027 Medicare Physician Fee Schedule changes may affect reimbursement by provider specialty and geographic locality, including conversion factor, GPCI, RVU, ...