Adjusting For Risk Selection In State Health Insurance Exchanges Will Be Critically Important And Feasible, But Not Easy.
The Affordable Care Act calls for the establishment of state-level health insurance exchanges. The viability and success of these exchanges will require effective risk-adjustment strategies to compensate for differences in enrollees' health status across health plans. This article describes why the...
| Publicado en: | Health Affairs Vol. 31; no. 2; pp. 306 - 316 |
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| Autores principales: | , , , |
| Formato: | Journal Article |
| Publicado: |
Health Affairs Publishing, LLC
Feb2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=74530914&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 74530914 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Feb2012 vid: 31 iid: 2 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 74530914 104555888 10.1377/hlthaff.2011.0420 74530914 ppf: 306 ppct: 10 formats: tig: atl: Adjusting For Risk Selection In State Health Insurance Exchanges Will Be Critically Important And Feasible, But Not Easy. aug: au: Weiner, Jonathan P. Trish, Erin Abrams, Chad Lemke, Klaus affil: professor of health policy and management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. sug: subj: Risk Management Methods State Government Managed Competition Methods Insurance, Health Human Selection Bias Age Factors Health Status Patient Protection and Affordable Care Act Government Regulations Computer Simulation Fees and Charges Standards Reimbursement, Incentive Health Services Accessibility Decision Making, Organizational Administrative Research Databases, Health Utilization United States Cluster Analysis Models, Statistical Utilization Predictive Validity Diagnosis-Related Groups Uncertainty ab: The Affordable Care Act calls for the establishment of state-level health insurance exchanges. The viability and success of these exchanges will require effective risk-adjustment strategies to compensate for differences in enrollees' health status across health plans. This article describes why the Affordable Care Act could lead to favorable or adverse risk selection across plans. It reviews provisions in the act and recent proposed regulations intended to mitigate the problem of risk selection. We performed a simulation that showed that under the premium rating restrictions in the law, large incentives for insurers to attract healthier enrollees will be likely to persist--resulting in substantial overpayment to plans with very healthy enrollees and underpayment to plans with very sick members. We conclude that risk adjustment based on patients' diagnoses, such as will be in place from 2014 on, will yield payments to insurers that will be more accurate than what will come solely from the age-adjusted and other rating allowed by the act. We also describe additional challenges of implementing risk adjustment. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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