Risk Adjustment
Expert articles and analysis related to risk adjustment.
AI Summary — Last 24 Hours
Risk adjustment scrutiny is intensifying across Medicare Advantage and ACA markets: KFF’s updated explainer on Medicare Advantage coding intensity reinforces the policy pressure on CMS to curb diagnosis-driven overpayments, while Health Affairs argues MA’s current risk-pricing defaults systematically reward coding rather than care improvement. At the same time, Wakely’s 2027 HHS-HCC model impact estimates point to material issuer-level effects in the ACA risk adjustment program, helping explain why Centene and Oscar shares rallied after analysts viewed recent risk-adjustment results as favorable. For VBC leaders, the immediate implication is tighter strategic linkage between documentation integrity, coding compliance, actuarial risk modeling, and performance management across Medicare Advantage and ACA lines of business.
Related Articles
Decoding Medicare Advantage Coding Intensity
Federal payments to Medicare Advantage plans, and adjustments for health status, have come under increased scrutiny. This brief answers key questions about coding intensity, recent steps taken by CMS,...
Final 2027 HHS HCC Risk Adjustment Model Impact Estimates
Final 2027 HHS HCC Risk Adjustment Model Impact Estimates  Wakely
Decoding Medicare Advantage Coding Intensity
Decoding Medicare Advantage Coding Intensity  KFF
Defaults Don’t Lie: Medicare Advantage’s Approach To Pricing Risk Is Broken
Defaults Don’t Lie: Medicare Advantage’s Approach To Pricing Risk Is Broken  Health Affairs
CNC, OSCR Stocks Rally After Baird Calls Risk Adjustment Results Favorable
CNC, OSCR Stocks Rally After Baird Calls Risk Adjustment Results Favorable  Asianet Newsable
CNC, OSCR Stocks Rally After Baird Calls Risk Adjustment Results Favorable
CNC, OSCR Stocks Rally After Baird Calls Risk Adjustment Results Favorable  Stocktwits