In-depth Analysis of 2024 CMS-HCC Model V28 Impact

The proposed CMS-HCC Risk Adjustment Model 2024 v28 includes significant changes and updates from the previous version, 2020 v24, which will impact RAF scores for Medical Advantage Organizations. This video is designed for in-depth analysis of changes include the revision of Hierarchical Condition Category (HCC) coefficients, which are used to predict medical costs for each member, and to better reflect the impact of certain health conditions on medical spending.

The payment year 2024 impact on MA risk scores of the proposed Part C CMS-HCC model, is projected to be -3.12%, which represents a $11.0 billion net savings to the Medicare Trust fund in 2024.

These are our findings for following overall population level:
Overall experiencing a range of -21% to -7% with an average of -14%.
New Enrollees would benefit from the model change, whereas Continuing Enrollees with Full & Partial Aged segments would be most negatively impacted.
There are some decreases in diseases interaction factors in V28. Populations with the multiple chronic conditions experiencing the largest decreases.

A large number of relatively common conditions will not map to a payment HCC in V28, indicating that RAF scores will decrease for many beneficiaries with Diabetes, Metabolic, Blood, Psychiatric, and Vascular disease groups, but Neoplasms, Heart, Lung, and Kidney disease groups see positive impacts.