News & Updates

IMI Launches Effort to Modernize Medicaid Risk Adjustment Model


August 10, 2021



IMI Launches Effort to Modernize Medicaid Risk Adjustment Model

The Institute for Medicaid Innovation (IMI) has launched a collaborative new project to update the Chronic Illness and Disability Payment (CDPS) risk adjustment weights, currently used by 22 state Medicaid programs.

The originally developed CDPS model used fee-for-service data from calendar years 2000 and 2001 with an update of the weights in 2011. As a result, neither the experience of managed care over the past 10 years nor the changes in the Medicaid program broadly (e.g., Medicaid expansion, expansion of managed care statewide, introduction of more complex populations into managed care, etc.) have been accounted for in the CDPS weights. Updating the weights through this project has the potential to assist states in more accurately implementing risk adjustment methodologies.

The Institute for Medicaid Innovation is working collaboratively with the original developers of the CDPS model, Drs. Todd Gilmer and Rick Kronick at the University of California San Diego, who will be independently conducting the update. This project will utilize three years of de-identified, minimal Medicaid managed care data sets from various populations and regions including Florida, Illinois, Kansas, Kentucky, Louisiana, Michigan, New Jersey, and Washington.

Risk adjustment is the use of claims and encounter data to adjust capitation payments (set amount per member per month) for Medicaid health plans based on their members’ health and projected costs of care. Risk adjustment models help ensure that health plans can provide affordable, accessible, and quality care. Moreover, risk adjustment encourages efficiency in care delivery, adequate financing of healthcare, and spurs innovation. Accurate data and rigorous data collection and analysis is critical to developing and maintaining risk adjustment models that promote effective care delivery.

The initial results from the first phase of the project are expected to be released by the end of 2021.

 

The Institute for Medicaid Innovation (IMI) seeks to improve the lives of Medicaid enrollees through the development, implementation, and diffusion of innovative and evidence-based models of care that promote quality, value, equity, and the engagement of individuals, families, and communities. IMI is a 501(c)3 nonprofit, nonpartisan research and policy organization focused on generating and disseminating evidence of innovative solutions that address important clinical, research, and policy issues in Medicaid through multi-stakeholder engagement, research, data analysis, education, learning collaboratives, and quality improvement initiatives.

The University of California, San Diego (UCSD) is a public land-grant research university in San Diego, California with over 200 undergraduate and graduate degree granting programs. UCSD consists of four academic divisions and seven professional schools and operates 19 organized research units. With over 40,000 students is ranked among the best universities in the world by major college and university rankings. UCSD alumni have won 27 Nobel Prizes, eight National Medals of Science, eight MacArthur Fellowships, and three Pulitzer Prizes. Furthermore, 29 current faculty have been elected to the National Academy of Engineering, 70 to the National Academy of Sciences, 45 to the Institute of Medicine, and 110 to the American Academy of Arts and Sciences.

 

Media Contact

Lydia Tonkonow

LTonkonow@MedicaidInnovation.org