scholarly journals New Risk-Adjustment System Was Associated With Reduced Favorable Selection In Medicare Advantage

2012 ◽  
Vol 31 (12) ◽  
pp. 2630-2640 ◽  
Author(s):  
J. Michael McWilliams ◽  
John Hsu ◽  
Joseph P. Newhouse
Keyword(s):  
Risk Adjustment ◽  
Medicare Advantage ◽  
Adjustment System

The Prospective Risk Adjustment System

1999 ◽  
Vol 22 (2) ◽  
pp. 41-52 ◽  
Author(s):  
Norbert Goldfield ◽  
Richard Averill ◽  
Jon Eisenhandler ◽  
John S. Hughes ◽  
John Muldoon ◽  
...  
Keyword(s):  
Risk Adjustment ◽  
Prospective Risk ◽  
Adjustment System

scholarly journals Favorable Selection, Risk Adjustment, and the Medicare Advantage Program

2012 ◽  
Vol 48 (3) ◽  
pp. 1039-1056 ◽  
Author(s):  
Michael A. Morrisey ◽  
Meredith L. Kilgore ◽  
David J. Becker ◽  
Wilson Smith ◽  
Elizabeth Delzell
Keyword(s):  
Risk Adjustment ◽  
Medicare Advantage

scholarly journals Does Risk Adjustment Reduce Vaccination in the Elderly? Evidence From Medicare Advantage

2018 ◽  
Vol 77 (2) ◽  
pp. 176-186
Author(s):  
Brett Lissenden ◽  
Rajesh Balkrishnan
Keyword(s):  
Influenza Vaccination ◽  
Risk Adjustment ◽  
Chronic Conditions ◽  
The Elderly ◽  
Positive Influence ◽  
Medicare Advantage ◽  
Vaccination Rates ◽  
Adjustment Policy ◽  
Percentage Points ◽  
Risk Adjustment Model

To combat risk selection, it is becoming increasingly common for payments to insurers (and providers) to adjust for patients’ chronic conditions. A possible unintended negative consequence is to reduce insurers’ (and providers’) incentives to prevent chronic conditions. This study examined the effect of Medicare’s risk adjustment for payments to Medicare Advantage plans, first introduced in 2004, on pneumonia and influenza vaccination for the elderly. The analysis used the 2000 through 2010 waves of the Medicare Current Beneficiary Survey and a difference-in-differences approach. Presumably by decreasing Medicare Advantage plans’ positive influence on vaccination, Medicare’s risk adjustment policy was estimated to have reduced pneumonia vaccination rates by 2.9 percentage points (4%, p = .039) and to have possibly reduced influenza vaccination rates by 2.2 percentage points (3%, p = .096). The results clarify an argument against including vaccine-preventable conditions, like pneumonia, in a risk adjustment model.

scholarly journals Assessment of the Medicare Advantage Risk Adjustment Model for Measuring Veterans Affairs Hospital Performance

2018 ◽  
Vol 1 (8) ◽  
pp. e185993 ◽  
Author(s):  
Todd H. Wagner ◽  
Peter Almenoff ◽  
Joseph Francis ◽  
Josephine Jacobs ◽  
Christine Pal Chee
Keyword(s):  
Risk Adjustment ◽  
Hospital Performance ◽  
Veterans Affairs ◽  
Medicare Advantage ◽  
Adjustment Model ◽  
Risk Adjustment Model

scholarly journals How the COVID-19 pandemic can distort risk adjustment of health plan payment

2021 ◽  
Author(s):  
Richard C. van Kleef ◽  
Mieke Reuser
Keyword(s):  
Conceptual Framework ◽  
Healthcare Utilization ◽  
Health Plan ◽  
Surgical Procedures ◽  
Risk Adjustment ◽  
Adjustment System ◽  
The Impact

AbstractThe 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.

scholarly journals Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries

2016 ◽  
Vol 74 (6) ◽  
pp. 736-749 ◽  
Author(s):  
Elizabeth M. Goldberg ◽  
Amal N. Trivedi ◽  
Vincent Mor ◽  
Hye-Young Jung ◽  
Momotazur Rahman
Keyword(s):  
Nursing Home ◽  
Risk Adjustment ◽  
Risk Selection ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Payment Model ◽  
Mortality Difference ◽  
Switch Rate ◽  
Reduced Risk

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans’ incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.

scholarly journals How Does Risk Selection Respond to Risk Adjustment? New Evidence from the Medicare Advantage Program

2014 ◽  
Vol 104 (10) ◽  
pp. 3335-3364 ◽  
Author(s):  
Jason Brown ◽  
Mark Duggan ◽  
Ilyana Kuziemko ◽  
William Woolston
Keyword(s):  
Adverse Selection ◽  
Risk Adjustment ◽  
Medical Costs ◽  
Risk Selection ◽  
Health Plans ◽  
Medicare Advantage ◽  
Capitation Payments ◽  
New Evidence

To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling “overpriced” individuals with costs significantly below the formula's prediction. Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. We find no evidence that overpayments were on net reduced. (JEL G22, H51, I13, I18)

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