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After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare
Sidra Haye, Mireille Jacobson, Geoffrey Joyce, Julie Zissimopoulos. Health Affairs, 2025-01-01
Topic: Risk, prevention and care in population studies
In 2020, the Centers for Medicare and Medicaid Services reintroduced Alzheimer's disease and related dementias to its risk-adjustment payment model for Medicare Advantage (MA) plans. Using 2017-20 data for 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how the reintroduction of dementia to the risk-adjustment model affected rates of new (incident) dementia diagnoses among beneficiaries enrolled in MA relative to those enrolled in traditional Medicare. In response to the payment change, annual incident dementia diagnosis rates in MA increased by 11.5 percent relative to traditional Medicare. This increase was concentrated among beneficiaries who were more likely to have undiagnosed dementia-specifically, beneficiaries who were Hispanic or Black, were ages eighty-five and older, or were dually eligible for Medicaid or received a Part D low-income subsidy. Only a third of the increase came through chart reviews. Financial incentives to detect dementia increased dementia diagnoses, particularly among beneficiaries at high risk for dementia and undetected dementia, but questions remain about potential overdiagnosis or upcoding.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Haye, S., Jacobson, M., Joyce, G., & Zissimopoulos, J. (2025). After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare. Health Affairs. https://doi.org/10.1377/hlthaff.2024.00723
Vancouver
Haye S, Jacobson M, Joyce G, Zissimopoulos J. After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare. Health Affairs. 2025. doi:10.1377/hlthaff.2024.00723. PMID: 39761458.
BibTeX
@article{haye2025-39761458,
author = {Haye, Sidra and Jacobson, Mireille and Joyce, Geoffrey and Zissimopoulos, Julie},
title = {{After Risk-Adjustment Change, Dementia Diagnoses Increased In Medicare Advantage Relative To Traditional Medicare}},
journal = {Health Affairs},
year = {2025},
doi = {10.1377/hlthaff.2024.00723},
pmid = {39761458},
url = {https://doi.org/10.1377/hlthaff.2024.00723}
}
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Key findings
- Using 2017-20 data for 100 percent of community-dwelling beneficiaries enrolled in Medicare, we evaluated how the reintroduction of dementia to the risk-adjustment model affected rates of new (incident) dementia diagnoses among beneficiaries enrolled in MA relative to those enrolled in traditional Medicare.
- In response to the payment change, annual incident dementia diagnosis rates in MA increased by 11.5 percent relative to traditional Medicare.
- This increase was concentrated among beneficiaries who were more likely to have undiagnosed dementia-specifically, beneficiaries who were Hispanic or Black, were ages eighty-five and older, or were dually eligible for Medicaid or received a Part D low-income subsidy.
- Only a third of the increase came through chart reviews.
- Financial incentives to detect dementia increased dementia diagnoses, particularly among beneficiaries at high risk for dementia and undetected dementia, but questions remain about potential overdiagnosis or upcoding.
Why it matters
This study found that reintroducing dementia to Medicare Advantage risk adjustment was associated with an 11.5 percent increase in incident dementia diagnoses relative to traditional Medicare. It does not test any treatment, cure, or prevention for Alzheimer's disease, and it raises questions about potential overdiagnosis or upcoding.
Study details
- Evidence strengthLow
How this study scored 40/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Health Affairs) |
| Journal's citation record | 3 / 4 | Health Affairs: journal h-index 277 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 5.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Julie Zissimopoulos: h-index 36 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Southern California: institution h-index 1,521 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 39761458) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 40 / 100 | — |
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