Are HCC Risk Scores a Reliable Health Status Indicator Across Rural and Urban Areas?

View Policy Brief

04/2025

This brief examines differences in Centers for Medicare & Medicaid Services Hierarchical Condition Category (HCC) risk scores between rural and urban Medicare Fee-for-Service (FFS) beneficiaries across four common chronic conditions: hypertension, diabetes, depression, and chronic obstructive pulmonary disease.

Key Takeaways

• HCC Geographic Variation: Rural residents have higher mortality rates and more chronic conditions than urban residents, yet HCC scores for rural Medicare FFS beneficiaries are consistently lower than for their urban counterparts, implying better overall health status for rural beneficiaries and lower health care costs.
• HCC Limitations: HCC scores, based on patients' demographics and claims data, may not fully capture rural beneficiaries' health complexities.
• HCC Policy Considerations: HCC scores inform health care payment models and resource allocation, potentially disadvantaging rural providers. Accurate health indicators are essential for resource allocation.

ETSU/NORC Rural Health Research Center

Craig Holden, Alana Knudson, Marilyn Klug, Samantha Augenbraun, Shena Popat

Healthcare access, Healthcare financing, Medicare, Medicare Advantage (MA)