A Big Change to Medicare Risk Adjustment: Incorporating Social Determinants of Health
Will SDoH reshape Medicare risk adjustment? For decades, the Centers for Medicare & Medicaid Services (CMS) has recognized that appropriate payment to Medicare Advantage (MA) plans needs to be based on the best available information. In the 1990s, CMS implemented a payment differential for members who are dually eligible for Medicare and Medicaid. This payment reflected the increased cost CMS associated with lower income members who had historically lower access to care. This