Objectives Medicare–Medicaid dual-eligible beneficiaries comprise 97%). System context reduced predicted risk for 86% of beneficiaries (mean −8.8 percentage points), while increasing risk for 14%. Black beneficiaries experienced higher rates of contextual risk amplification (15.8% vs 13.6% White) and showed distinct vulnerability to large practice coordination and workforce composition factors, while Hispanic populations’ risk was primarily associated with geographic access barriers. Conclusions Healthcare delivery context substantially improves prediction of future spending among dual-eligible beneficiaries. These findings suggest risk adjustment incorporating context should account for differential racial impacts.
Patel et al. (2026) studied this question.