Unfairness Toward Rural Beneficiaries in Medicare's Hierarchical Conditions Categories Score

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Evaluates the Centers for Medicare & Medicaid Services (CMS) Hierarchical Condition Category (HCC) to determine its usefulness in accurately predicting risk for rural and urban patients. Assesses rural and urban risk by mortality rates and compares findings with HCC's measure of spending to identify risk. Discusses implications of findings related to reimbursement rates, healthcare access, social determinants of health, and Medicare Advantage enrollment. Offers potential solutions to address study findings.

Ravi B. Parikh, Kristin A. Linn, Junning Liang, et al

Health Affairs Scholar, 3(9)

09/2025

Access · Health insurance · Medicare · Mortality · Reimbursement and payment models · Rural-urban differences · Social determinants of health · Statistics and data