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Literature DB >> 24308878

Integrating risk adjustment and enrollee premiums in health plan payment.

Thomas G McGuire¹, Jacob Glazer, Joseph P Newhouse, Sharon-Lise Normand, Julie Shi, Anna D Sinaiko, Samuel H Zuvekas.

Abstract

In two important health policy contexts - private plans in Medicare and the new state-run "Exchanges" created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance markets based on fitting total plan payments to health plan costs per person as closely as possible. A least squares regression including both health status and variables used in premiums reveals the weights a Regulator should put on risk adjusters when markets determine premiums. We apply the methods to an Exchange-eligible population drawn from the Medical Expenditure Panel Survey (MEPS).

Entities: Chemical Disease Gene Species

Keywords: Exchanges; Health insurance; I13; I18; Medicare; Premiums; Risk adjustment

Mesh：

Year: 2013 PMID： 24308878 PMCID： PMC3855655 DOI： 10.1016/j.jhealeco.2013.05.002

Source DB: PubMed Journal: J Health Econ ISSN： 0167-6296 Impact factor: 3.883

12 in total

1. Measuring adverse selection in managed health care.

Authors: R G Frank; J Glazer; T G McGuire
Journal: J Health Econ Date: 2000-11 Impact factor: 3.883

2. Payment policy and inefficient benefits in the Medicare+Choice program.

Authors: Steven D Pizer; Austin B Frakt; Roger Feldman
Journal: Int J Health Care Finance Econ Date: 2003-06

3. A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1).

Authors: A Enthoven; R Kronick
Journal: N Engl J Med Date: 1989-01-05 Impact factor: 91.245

Integrating risk adjustment and enrollee premiums in health plan payment.

1. Measuring adverse selection in managed health care.

2. Payment policy and inefficient benefits in the Medicare+Choice program.

3. A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1).

4. The structure of risk adjustment for private plans in Medicare.

5. The Medicare reform debate: what is the next step?

6. An economic history of Medicare part C.

7. Gold and silver health plans: accommodating demand heterogeneity in managed competition.

8. Complex Medicare advantage choices may overwhelm seniors--especially those with impaired decision making.

9. Making Medicare advantage a middle-class program.

10. Risk adjustment of Medicare capitation payments using the CMS-HCC model.

1. Overpaying morbidity adjusters in risk equalization models.

2. Risk transfer formula for individual and small group markets under the Affordable Care Act.

3. How successful is Medicare Advantage?

4. Assessing incentives for service-level selection in private health insurance exchanges.

5. Simulating Variation in Families' Spending across Marketplace Plans.

6. HOW MUCH FAVORABLE SELECTION IS LEFT IN MEDICARE ADVANTAGE?

7. RISK CORRIDORS AND REINSURANCE IN HEALTH INSURANCE MARKETPLACES: Insurance for Insurers.

8. Measuring efficiency of health plan payment systems in managed competition health insurance markets.

9. Risk adjustment in aging societies.

10. Improving risk equalization with constrained regression.