Brown University School of Public Health Reports Findings in Managed Care (Exposure to the new Medicare Advantage risk adjustment model varies across insurers): Managed Care

2026 MAY 19 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Current study results on Managed Care have been published. According to news originating from Providence, Rhode Island, by NewsRx correspondents, research stated, “Medicare Advantage plan payment depends on the health of enrolled patients. As a result, the extent to which beneficiary clinical severity is documented administratively-known as coding intensity-is greater in Medicare Advantage (MA) than in traditional Medicare, which inflates payment to plans.”

Our news journalists obtained a quote from the research from the Brown University School of Public Health, “In 2024, the Centers for Medicare and Medicaid Services began phasing in a new risk adjustment model intended to reduce the susceptibility of MA payments to higher coding intensity. Using 2021 data, we compared average MA contract risk scores under the new model and the old model. Risk scores were 5.8% lower under the new risk adjustment model. Differences between average risks scores under the new and old model varied substantially across contracts and insurers. For example, 1 large insurer’s risk scores were essentially unchanged across models while another large insurer’s risk score was 18% lower under the new model. Contracts with higher estimated coding intensity had greater exposure to the new risk adjustment model.”

According to the news editors, the research concluded: “Our results suggest that the new risk adjustment model will likely reduce MA payments due to enhanced coding intensity, with these reductions appropriately targeting insurers that code more intensely.”

This research has been peer-reviewed.

For more information on this research see: Exposure to the new Medicare Advantage risk adjustment model varies across insurers. Health Affairs Scholar, 2026;4(5).

The news correspondents report that additional information may be obtained from Andrew M. Ryan, Dept. of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI 02903, United States. Additional authors for this research include Jeffrey Marr and David J. Meyers.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1093/haschl/qxag092. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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