Great article! Thank you for writing! Any further thoughts in relation to MA plans massively overcharging? You're last paragraph was, unfortunately, prescient
On the positive side: risk adjustment is a critical mechanism to make MA and also ACA plans work. At it's core health plans are still an insurance product and people have variable expected health are costs.
You either need to allow health plans to adjust their premiums based on the expected cost for certain cohorts or create a risk-pool exchange. Otherwise the whole system would not be financially sustainable as long as insurers have to accept any member application.
I think the mechanism needs rework rather than be abolished.
Amazing post. I really appreciate your efforts.
https://cosentus.com/healthcare-revenue-cycle-management/
Great article! Thank you for writing! Any further thoughts in relation to MA plans massively overcharging? You're last paragraph was, unfortunately, prescient
https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html
Any positive news?
On the positive side: risk adjustment is a critical mechanism to make MA and also ACA plans work. At it's core health plans are still an insurance product and people have variable expected health are costs.
You either need to allow health plans to adjust their premiums based on the expected cost for certain cohorts or create a risk-pool exchange. Otherwise the whole system would not be financially sustainable as long as insurers have to accept any member application.
I think the mechanism needs rework rather than be abolished.