Issue Brief

Understanding Risk Adjustment in Medicare Advantage

Better Medicare Alliance presents the paper, “Understanding Risk Adjustment in Medicare Advantage.” 

Medicare Advantage relies on accurate and stable risk adjustment that ensures plans and practitioners are able to provide high value care to all beneficiaries, including those with complex health needs. Clinical identification of health status that reflects the needs of beneficiaries allows Medicare Advantage to provide care coordination and slow disease progression, essential to quality care and improved health of beneficiaries.

With one-third---17 million Medicare-eligible beneficiaries choosing Medicare Advantage, this paper offers a clear explanation of the importance of risk adjustment process and its critical components.  

These include:

  • Key Differences Between Medicare Advantage and Traditional Fee-For-Service Medicare
  • Focus on Chronic Disease in Medicare Advantage
  • Risk Adjustment Methodology
  • Clinical Coding Patterns
  • Recent Modifications to Risk Scores
  • Real Life Examples of Risk Adjusted Payment Models