On February 1, 2023, CMS released the Medicare Advantage (MA) Advance Notice which is a document used to give notice to MA plans about upcoming changes to the model for the following performance year. As we outlined in our prior blog post, the Advance Notice contained substantial changes to the risk scoring model. CMS provided the methodology for calculating risk scores (the program code) on February 17, 2023 and CareJourney has spent the last several weeks implementing that code, analyzing the impacts of the new risk scoring methodology along several axes, and partnering with Duke Margolis on a comment letter to reflect on our early findings, including a recommendation to transition to the use of clinical data sourced from certified electronic health records systems to improve model accuracy.
As we spoke to our members, thought partners and current/former policymakers, the common concern about the new model was that it would likely have a greater impact on Medicare Advantage plans that serve a higher population of minority beneficiaries or beneficiaries who are eligible for both Medicare and Medicaid simultaneously (“dual eligible beneficiaries”). In our analysis we looked at these two groupings as well as impacts on beneficiaries residing in “economically distressed” zip codes. We further analyzed the impact of the new model on several disease groups such as diabetes, depression, and congestive heart failure.