Becker's Healthcare December 19, 2025
CMS is seeking input on whether its risk adjustment system disadvantages smaller Medicare Advantage plans, and one regional plan CEO says the answer is an emphatic yes.
In its 2027 proposed MA rule, CMS said it recognizes the current risk adjustment system “may disadvantage smaller, newer, and less well-resourced plans” and may incentivize plans to prioritize coding activities over care management. The agency said it is exploring a next-generation risk adjustment model that could leverage artificial intelligence and alternative data sources.
Sachin Jain, MD, president and CEO of SCAN Group, told Becker’s that CMS has blind spots when it comes to understanding how national plans are squeezing out regional competitors.
“I frequently say we’re in a David versus Goliath battle...
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