New risk score methodology is finalized
The payment growth will be higher than anyone had expected in 2022, but the revenue increase may be offset for some payers, because of the changes in the risk adjustment factor (RAF) score calculation. However, the challenge for MA plans, is that the data remains incomplete, in order to calculate an accurate score.
With members foregoing care, HCCs could be either missing or overlooked. You can encourage members to seek preventive care or chronic condition management if you want to improve the accuracy of the scores, but MA payers can also expect a small financial loss for each member per year, due to the EDS transition and incomplete data.