A must watch: New CMS video signals new metric for Medicare Advantage

By Jason Jobes

The 2027 Medicare Advantage final rate notice is out—and the buzz is everywhere. Let me just say I rarely pause to watch a video, much less one that is 20 minutes.

This one is a MUST watch if you are in risk adjustment.

Last week “Health Tech Nerds” hosted an interview with Medicare Director Kris Klomp. Being a healthcare nerd myself, and knowing my audience, I think you’ll like it. See the link below.

It’s a refreshing (and brutally honest) take from the CMS exec and should give pause to anyone who works in our space. I know I paused on a few of Klomp’s choice quotes.

In case you’re wondering why the abrupt reversal from the 0.09% proposed increase in the advance notice to the 2.48% final, Klomp says CMS received “well over 40,000 comments” from the industry. I did find an earlier Beckers article from March fascinating where they said 80%+ of the comments were identical and from patients protesting the impact of the notice.

Safe to say the vast majority of those were not of the “yay, CMS!” type. It was harsh critique of the proposed model revision. Klomp called it a “learning experience”:

“We heard loud and clear from many folks that additional time for them to reach a period of stability, to catch their breath, would be a good thing,” he said.

But, in turn for this needed pause, CMS is expecting much better behavior from the MA community, in particular big health plans. “We are sending a very loud signal, not just to Medicare Advantage payers, but to providers who care for our beneficiaries: The days of unlimited increases in rate must end,” Klomp says.

Gone are the days of inflating RAF scores at all costs. Klomp sets his sights squarely on risk adjustment coding games.

Of the permanent removal of unlinked chart reviews from risk adjustment consideration, he says:

“We will not reward risk coding games, or rev. cycle games. We want to reward participants who win on the basis of helping our beneficiaries lead their healthiest lives.” Not leveraging competitive advantage to improve risk scores, Klomp emphasizes, again and again.

It’s a clear signal that we must begin to seriously address the “O” in the O/E ratios we’ve been working to improve.

The rules have been drawn: Driving costs down, not driving up care funding. CMS is going to level out the playing field regardless of how good you think you are at playing the game. It is leaning harder into incentivized accountable care arrangements and will use every tool in its toolbox to accomplish that mission.

“We want folks competing on the basis of generating exceptional, cost adjusted quality outcomes.”

Watch the interview and let me know what you think. I would love to hear your thoughts on the video. Reach out anytime at jason@norwood.com.

Watch the video here:

Health Tech Nerds, Chris Klomp: 2027 MA final rate notice, accountable relationships, and opportunity for startups: https://www.youtube.com/watch?v=5xvrTJDmT-k