The Next Phase of Risk Adjustment for Prospective Payment: Advancing Equity and Addressing Coding

The overarching goal of this project is to inform improvements to the risk adjustment system that support the social goals of a population-based payment system. The research team will use 2010–2018 national survey data (Consumer Assessment of Healthcare Providers and Systems) with linked Medicare claims to execute the following two research aims: 1) estimate the relationships between race and ethnicity or education on total Medicare spending after adjustment for demographic and clinical factors included in current risk adjustment methods; and 2) explore the use of patient survey data reflecting true health risk to design “smart caps” on risk scores that mitigate incentives for coding while better preserving the ability of current risk adjustment methods to discourage risk selection.