Steps To Reduce Favorable Risk Selection In Medicare Advantage Largely Succeeded, Boding Well For Health Insurance Exchanges.
Within Medicare, the Medicare Advantage program has historically attracted better risks-healthier, lower-cost patients-than has traditional Medicare. The disproportionate enrollment of lower-cost patients and avoidance of higher-cost ones during the 1990s-known as favorable selection--resulted in Me...
| Publicado en: | Health Affairs Vol. 31; no. 12; pp. 2618 - 2629 |
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| Autores principales: | , , , , |
| Formato: | Journal Article |
| Publicado: |
Health Affairs Publishing, LLC
Dec2012
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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=84367681&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 84367681 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 02782715 HAF jtl: Health Affairs issn: 02782715 maglogo: N pubinfo: dt: Dec2012 vid: 31 iid: 12 pid: 1453 pub: Health Affairs Publishing, LLC place: Washington, District of Columbia artinfo: ui: 84367681 108085658 10.1377/hlthaff.2012.0345 84367681 ppf: 2618 ppct: 11 formats: tig: atl: Steps To Reduce Favorable Risk Selection In Medicare Advantage Largely Succeeded, Boding Well For Health Insurance Exchanges. aug: au: Newhouse, Joseph P. Price, Mary Huang, Jie Mcwilliams, J. Michael Hsu, John affil: John D. MacArthur Professor of Health Policy and Management, director, Division of Health Policy Research and Education, chair, Committee on Higher Degrees in Health Policy, and director, Interfaculty Initiative in Health Policy, Harvard University, Boston, Massachusetts sug: subj: Managed Competition Methods Medicare Statistics and Numerical Data Selection Bias Trends Managed Care Programs Classification Risk Management Methods Organizational Policies Human United States Eligibility Determination Fee for Service Plans Comparative Studies Administrative Research Predictive Validity Health Care Costs Mortality Case Mix Diagnosis-Related Groups Prospective Payment System Methods Prospective Studies United States Billing and Claims Statistics and Numerical Data Geographic Factors Models, Statistical Utilization Confidence Intervals Decision Making, Patient Funding Source ab: Within Medicare, the Medicare Advantage program has historically attracted better risks-healthier, lower-cost patients-than has traditional Medicare. The disproportionate enrollment of lower-cost patients and avoidance of higher-cost ones during the 1990s-known as favorable selection--resulted in Medicare's spending more per beneficiary who enrolled in Medicare Advantage than if the enrollee had remained in traditional Medicare. We looked at two measures that can indicate whether favorable selection is taking place--predicted spending on beneficiaries and mortality--and studied whether policies that Medicare implemented in the past decade succeeded in reducing favorable selection in Medicare Advantage. We found that these policies--an improved risk adjustment formula and a prohibition on monthly disenrollment by beneficiaries--largely succeeded. Differences in predicted spending between those switching from traditional Medicare to Medicare Advantage relative to those who remained in traditional Medicare markedly narrowed, as did adjusted mortality rates. Because insurance exchanges set up under the Affordable Care Act will employ similar policies to combat risk selection, our results give reason for optimism about managing competition among health plans. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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