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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Bibliographic Details
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
Description
Summary: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.