As CMS transitions the calculation of Medicare Advantage (MA) plan risk scores from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS), questions remain regarding how the shift may impact future MA plan payment rates.

Introduction
As CMS transitions the calculation of Medicare Advantage (MA) plan risk scores from the Risk Adjustment Processing System (RAPS) to the Encounter Data System (EDS), questions remain regarding how the shift may impact future MA plan payment rates.

This report presents the analysis of revised 2016 risk scores resulting from EDS, based on the recently released MAO-004 reports. Six Medicare Advantage organizations (MAOs) participated in the study, representing over 760,000 Medicare beneficiaries from 30 different H-contracts, with members represented from all 50 states.  The findings are the result of a research collaboration between Inovalon, Avalere, the RISE Association, and industry partners that puts in perspective how the shift from a RAPS-based risk adjustment factor to one that is calibrated using full encounter data may affect payment rates for your organization. To ensure you have the right resources in place for accurate, compliant and timely submissions, read this report.

Christie Teigland, Vice President of Advanced Analytics, is an expert in the design and implementation of statistical studies focused on comparative effectiveness, predictive analytics, and performance measure development and testing.  She advises clients on research protocols designed to answer questions about intervention and treatment effectiveness, predict relative risk of adverse health events, and the impact of regulatory and system changes on outcomes, Star ratings and costs.    Prior to joining Avalere, Christie served as Senior Director, Statistical Research at Inovalon where she managed performance measure development projects awarded by the National Committee on Quality Assurance (NCQA), URAC and other organizations.  In 2014-15, she directed an impactful study investigating disparities in outcomes in dual eligible and disadvantaged Medicare beneficiaries.  Dr. Teigland was invited to serve on the newly formed National Quality Forum (NQF) Disparities Standing Committee in 2015.  She served as co-chair of the Pharmacy Quality Alliance (PQA) Measures Update Panel and participates in the PQA risk adjustment panel.

Dr. Teigland was Vice President of 2020 Initiatives at Leading Age New York and Director of Special Projects for the Foundation for Long Term Care where she directed the development of innovative technology solutions to advance the use of data-driven decision making to improve outcomes and reduce healthcare costs.  She served on several CMS expert panels including the Nursing Home Quality Measures Technical Expert Panel, Five Star Quality Rating System Workgroup and field-testing of AHRQ CAHPS satisfaction and patient safety tools, and on national expert panels including a RAND expert panel that prioritized national patient safety measures; AHRQ Care Planning Expert Panel; MDS 3.0 Validation Panel, a CMS funded project to set national performance goals, and the NYS QIO Steering Committee.  She participates in the American Medical Director’s Association (AMDA) Technology Work Group.    Dr. Teigland received her Ph.D. in Economics from the University of New York at Albany and has a B.A. in Management Science and Economics from Moorhead State University.