Risk Adjustment

MedPAC’s latest work on Medicare Advantage risk adjustment accuracy keeps pressure on CMS under the Trump administration to tighten plan-level payment calibration and coding oversight, a direct concern for MA plans, ACOs, and provider groups whose revenue models depend on diagnosis capture and risk-score integrity. At the same time, investor reaction to favorable MA and ACA risk-adjustment signals—especially for UNH, HUM, CNC, and OSCR—shows markets are pricing regulatory outcomes as material to payer margins, while provider enablement firms such as Privia are pushing AI-supported coding and care-gap workflows as infrastructure for VBC performance.