How the Changes Proposed in the MA Advance Notice Impact Industry Stakeholders

Overview

On February 1, CMS released the Medicare Advantage (MA) Advance Notice to notify MA plans of upcoming changes to the model for performance year 2024. Of the high-impact changes announced, one of the most substantial updates has been to the risk scoring model, as CMS uses risk scores to predict the cost of a beneficiary’s care for the performance year.

CareJourney participated in the comment period with industry research partners Duke-Margolis, using CMS’ new risk adjustment methodology to analyze its impacts along several axes. Our experts explained the findings of our analyses, and the implications of these changes for different stakeholders, answering pressing questions including:

• What are the major changes between v24 and v28 of the HCC risk adjustment model?
• What kind of groups will experience the biggest impacts?
• What are the impacts of adjusted risk scoring on MA beneficiaries, and dual eligible beneficiaries?
• What are the impacts of the removal of 2,300 HCC codes, including which disease groups would experience the greatest changes?