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Risk Adjustment, Insurance Markets, And More.

The article discusses various aspects of health care markets, focusing on risk adjustment, insurance competition, provider payment rates, and access to care. It highlights findings on upcoding in Medicare Advantage (MA) plans, undercoding in traditional Medicare, and the paradox of increasing concen...

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Published in:Health Affairs Vol. 43; no. 12; pp. 1613 - 1614
Main Author: WEIL, ALAN R.
Format: editorial Journal Article
Published: Health Affairs Publishing, LLC Dec2024
Online Access:View this record in EBSCOhost
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      dt: Dec2024
      vid: 43
      iid: 12
      pid: 1453
      pub: Health Affairs Publishing, LLC
      place: Washington, District of Columbia
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        10.1377/hlthaff.2024.01479
        190587904
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        atl: Risk Adjustment, Insurance Markets, And More.
      aug:
        au: WEIL, ALAN R.
      sug:
        subj:
          Coding
          Risk Assessment
          Health Insurance Exchanges
          Prospective Payment System
          Health Services Accessibility
          Serial Publications
          Patient Protection and Affordable Care Act
          Medicare
          Insurance Coverage
          Hospitals, Rural
          Health Facility Closure
      ab: The article discusses various aspects of health care markets, focusing on risk adjustment, insurance competition, provider payment rates, and access to care. It highlights findings on upcoding in Medicare Advantage (MA) plans, undercoding in traditional Medicare, and the paradox of increasing concentration among MA plans despite local competition. Additionally, it examines the implications of payment rates in different insurance markets, the financial challenges faced by rural hospitals, and the decline of retail pharmacies in predominantly Black neighborhoods. The article emphasizes the need for improved regulation and support for rural health care access.
      pubtype: Academic Journal
      doctype:
        editorial
        Journal Article
      ougenre: Article
    language: English
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