January 26, 2026
Contact: Mary Clare (Mimi) Toomey, APG Vice President of Communications
Email: MToomey@apg.org
Tel: (202) 322-9729
The newly released 2027 Medicare Advantage (MA) Advance Notice heralds a period of greater instability for the MA program, building on the disruption that MA has experienced in recent years and creating further strain for both MA enrollees and the contracted providers caring for them, America’s Physician Groups (APG) said today. APG’s roughly 330 physician organizations care for an estimated 1 out of 3 Medicare Advantage enrollees nationwide.
“The fact that average payments to MA plans are expected to increase by just 0.09 percent from 2026 to 2027 signals a far less favorable environment than many of our organizations and other stakeholders expected, given costs and recent pressures on the system,” said Susan Dentzer, president and CEO of APG. She noted that APG is especially concerned that CMS’s projected effective growth rate of 4.97 percent does not comport with rising rates of health care utilization and the direct experience of APG members, including many who are partnered with MA health plans in two-sided risk arrangements and see the evidence of rising utilization daily. The combination of a lower-than-anticipated effective growth rate and the relatively low payment increase of 0.09 percent “will impair the ability of many of our groups to care effectively for beneficiaries and meet their needs,” Dentzer said.
APG is also concerned about further proposed changes made in risk adjustment methodology, given that many physician groups and plan partners are still absorbing the impact of the three-year move to the Version 28 risk adjustment changes. APG seeks more detail from CMS on proposed changes such as removing diagnoses from chart reviews unless they are linked to an encounter, as well as discounting diagnoses collected from audio-only telehealth visits. Of particular interest is how these changes will affect diagnoses from chart reviews that are linked to the many non-visit-related clinical activities that APG groups undertake to support patients, as well as the effect on patients in rural areas or with low connectivity who rely on audio-only visits.
APG looks forward to further analyzing the proposed changes in the Advance Notice, many of which are highly technical, and to responding to CMS with comments from its member organizations.
About America’s Physician Groups
APG’s approximately 340 physician groups comprise 260,000 physicians and other clinicians providing care to nearly 90 million patients, including an estimated 1 in 4 Americans and 1 in 3 Medicare Advantage enrollees. APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
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