Risk Adjustment for Alzheimer Disease and Related Dementias in Medicare Advantage and Health Care Experiences

Was reinstating Alzheimer disease and related dementias (ADRD) hierarchical condition categories (HCCs) into the Medicare Advantage (MA) risk-adjusted payment model in 2020 associated with changes in care experiences for beneficiaries with ADRD?In this cross-sectional study of 5353 MA observations (2015-2022), reinstating the ADRD HCC was associated with a 6.6 percentage-point decline in reported care access difficulties and a 9.2 percentage-point decline in reported medical financial burden, with no significant changes in satisfaction with specialist access and satisfaction with care quality.These findings suggest that risk adjustment models that more accurately reflect the costs of complex chronic conditions may promote health equity.

Corresponding Author: Xi Chen, PhD, Department of Health Policy and Management, Yale School of Public Health, 60 College St, Ste 301, New Haven, CT 06520 (xi.chen@yale.edu).

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