{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:29:53Z","timestamp":1789046993701,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["1R01AG069352\u201001A1"],"award-info":[{"award-number":["1R01AG069352\u201001A1"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the Centers for Medicare and Medicaid Services (CMS) Hierarchical Condition Category (HCC) risk model using Medicare Advantage (MA) encounter data, as an initial step toward recalibrating risk\u2010adjusted MA payments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Study Setting<\/jats:title>\n                    <jats:p>A 20% sample of Traditional Medicare (TM) claims and MA encounter data for 2016\u20132022. Standardized fee schedules provide a measure of resource use in TM claims and MA encounters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Ordinary least squares regression replication of the CMS HCC version 28 model for relative resource use among community\u2010dwelling, non\u2010dual aged and disabled individuals. Robustness testing includes replication with version 22 model structure, sensitivity to MA chart review records, MA contracts with complete encounter data, and patterns of care during the COVID pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Using TM data from 2016 to 2022 results in modest changes in estimated coefficients and 1.7% lower average HCC scores, relative to 2018\u20132019 TM data used for CMS's HCC model v28. Using MA data result in 8.9% lower average scores than TM\u2010based scores. The differences between MA\u2010 and TM\u2010based HCC scores vary across the distribution of scores. When re\u2010estimating HCC v28 coefficients, increasing trends in TM and MA diagnosis prevalence are associated with smaller (diluted) coefficients in TM and MA\u2010based HCC risk models. Trends in medical technology can increase (e.g., high\u2010cost targeted cancer therapies) or decrease (e.g., lower\u2010cost biosimilars) HCC model coefficients, with evidence of larger technology\u2010related decreases in an MA\u2010based model. The decrease in MA\u2010based scores does not create new disincentives to enroll beneficiaries who are racial\/ethnic minorities or rural residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We make an important contribution to the policy debate about MA risk adjustment. Any changes in risk\u2010adjusted MA payment need to be reviewed in the full context of MA payment policy and MA plan enrollment incentives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70165","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:49:18Z","timestamp":1789044558000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk Adjustment in the Medicare Advantage Population Using Encounter Data"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0813-3433","authenticated-orcid":false,"given":"Caroline S.","family":"Carlin","sequence":"first","affiliation":[{"name":"Department of Family Medicine and Community Health, School of Medicine University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Feldman","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management, School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7574-0677","authenticated-orcid":false,"given":"Jeah","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Health Administration and Policy, College of Public Health George Mason University  Fairfax Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Centers for Medicare and Medicaid Services \u201cRisk Adjustment \u201daccessed May 31 2022 https:\/\/www.cms.gov\/Medicare\/Health\u2010Plans\/MedicareAdvtgSpecRateStats\/Risk\u2010Adjustors."},{"issue":"2","key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.1468-0009.2011.00629.x","article-title":"An Economic History of Medicare Part C","volume":"89","author":"McGuire T. 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