ArticleHealth affairs (Project Hope)2023
Risk Adjustment And Promoting Health Equity In Population-Based Payment: Concepts And Evidence.
Article in Health affairs (Project Hope), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
20 citing papers in PubMed.
- A Machine Learning Model to Improve Risk Adjustment Accuracy in Medicare.Health services research · 2026Article
- Increasing the Probability of Comparing Between Traditional Medicare and Medicare Advantage.Health literacy research and practice · 2026Article
- Do policy context and structural disadvantage shape SNF VBP performance? Evidence from national facility-year data.Health affairs scholar · 2026Article
- Social Risk Adjustment and Bonus Eligibility in Medicare Advantage Star Ratings.JAMA health forum · 2026Article
- Comparing US medicare coverage options as a contributing mechanism to sticking or switching to an insurance plan.BMC health services research · 2026Article
- Medicaid Primary Care Utilization and Area-Level Social Vulnerability.JAMA health forum · 2025Article
- Do MA plans follow incentives to attract enrollee groups with new supplemental benefits?Health affairs scholar · 2025Article
- Algorithms to Improve Fairness in Medicare Risk Adjustment.JAMA health forum · 2025Article
- Risk Adjustment in Capitation Payments to Primary Care Providers: Does It Matter How We Account for Patients' Socioeconomic Status?Medical care · 2025Article
- A critical review of the use of RThe European journal of health economics : HEPAC : health economics in prevention and care · 2025Review
- Incorporating area-level social drivers of health in predictive algorithms using electronic health record data.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Supporting Primary Care for Medically and Socially Complex Patients in Medicaid Managed Care.JAMA network open · 2025Article
- A Framework for the Design of Risk-Adjustment Models in Health care Provider Payment Systems.Medical care research and review : MCRR · 2025Review
- Use Of Patient Health Survey Data For Risk Adjustment To Limit Distortionary Coding Incentives In Medicare.Health affairs (Project Hope) · 2025Article
- Launching Financial Incentives for Physician Groups to Improve Equity of Care by Patient Race and Ethnicity.The Milbank quarterly · 2024Article
- Arthroscopy Patients in Medicare Population Became Sicker While Reimbursement Decreased From 2013 to 2020.Arthroscopy, sports medicine, and rehabilitation · 2024Article
- A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas.JAMA health forum · 2024Article
- Paying for Medical and Social Complexity in Massachusetts Medicaid.JAMA network open · 2023Article
- Beyond demonstrations: implementing a primary care hybrid payment model in Medicare.Health affairs scholar · 2023Review
- The Better Care Plan: a blueprint for improving America's healthcare system.Health affairs scholar · 2023Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
The objective of risk adjustment is not to predict spending accurately but to support the social goals of a payment system, which include equity. Setting population-based payments at accurate predictions risks entrenching spending levels that are insufficient to mitigate the impact of social determinants on health care use and effectiveness. Instead, to advance equity, payments must be set above current levels of spending for historically disadvantaged groups. In analyses intended to guide such reallocations, we found that current risk adjustment for the community-dwelling Medicare population overpredicts annual spending for Black and Hispanic beneficiaries by $376-$1,264. The risk-adjusted spending for these populations is lower than spending for White beneficiaries despite the former populations' worse risk-adjusted health and functional status. Thus, continued movement from fee-for-service to population-based payment models that omit race and ethnicity from risk adjustment (as current models do) should result in sizable resource reallocations and incentives that support efforts to address racial and ethnic disparities in care. We found smaller overpredictions for less-educated beneficiaries and communities with higher proportions of residents who are Black, Hispanic, or less educated, suggesting that additional payment adjustments that depart from predictive accuracy are needed to support health equity. These findings also suggest that adding social risk factors as predictors to spending models used for risk adjustment may be counterproductive or accomplish little.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.