The COVID-19 pandemic has led to disruptions in healthcare utilization and spending. While some changes might persist (e.g. substitution of specialist visits by online consultations), others will be transitory (e.g. fewer surgical procedures due to cancellation of treatments). This paper discusses the implications of transitory changes in healthcare utilization and spending for risk adjustment of health plan payment. In practice, risk adjustment methodologies typically consist of two steps: (1) calibration of payment weights for a given set of risk adjusters and (2) calculation of payments to insurers by combining the calibrated weights with enrollee characteristics. In this paper, we first introduce a simple conceptual framework for analyzing the (potential) distortions from the pandemic for both steps and then provide a hypothetical illustration of how these distortions can lead to under- or overpayment of insurers. The size of these under-/overpayments depends on (1) the impact of the pandemic on patterns in utilization and spending, (2) the distribution of risk types across insurers, (3) the extent to which insurers are disproportionately affected by the pandemic, and (4) features of the risk adjustment system.

COVID-19 大流行导致医疗保健利用和支出中断。虽然有些变化可能会持续存在（例如，通过在线咨询取代专科医生），但其他变化将是暂时的（例如，由于取消治疗而减少了外科手术）。本文讨论了医疗保健利用和支出的短暂变化对健康计划支付风险调整的影响。在实践中，风险调整方法通常包括两个步骤：（1）校准一组给定的风险调整者的支付权重；（2）通过将校准权重与参与者特征相结合来计算对保险公司的支付。在这篇论文中，我们首先介绍了一个简单的概念框架，用于分析大流行对这两个步骤的（潜在）扭曲，然后假设说明这些扭曲如何导致保险公司支付不足或多付。这些少付/多付的规模取决于 (1) 大流行对使用和支出模式的影响，(2) 保险公司之间风险类型的分布，(3) 保险公司受到大流行影响的程度, (4) 风险调整系统的特点。