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Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage.
- Source :
-
Health affairs (Project Hope) [Health Aff (Millwood)] 2016 Jun 01; Vol. 35 (6), pp. 1022-8. - Publication Year :
- 2016
-
Abstract
- Under the Affordable Care Act, the risk-adjustment program is designed to compensate health plans for enrolling people with poorer health status so that plans compete on cost and quality rather than the avoidance of high-cost individuals. This study examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. Through a simulation of the program on a population constructed to reflect Marketplace enrollees, we analyzed the cost consequences for plans enrolling people with mental health and substance use disorders. Our assessment points to systematic underpayment to plans for people with these diagnoses. We document how Marketplace risk adjustment does not remove incentives for plans to limit coverage for services associated with mental health and substance use disorders. Adding mental health and substance use diagnoses used in Medicare Part D risk adjustment is one potential policy step toward addressing this problem in the Marketplaces.<br /> (Project HOPEāThe People-to-People Health Foundation, Inc.)
- Subjects :
- Adult
Chronic Disease economics
Female
Health Insurance Exchanges economics
Humans
Insurance Coverage economics
Insurance, Health economics
Insurance, Health legislation & jurisprudence
Male
Patient Protection and Affordable Care Act economics
Risk Adjustment legislation & jurisprudence
United States
Computer Simulation
Mental Disorders economics
Motivation
Risk Adjustment economics
Substance-Related Disorders economics
Subjects
Details
- Language :
- English
- ISSN :
- 1544-5208
- Volume :
- 35
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Health affairs (Project Hope)
- Publication Type :
- Academic Journal
- Accession number :
- 27269018
- Full Text :
- https://doi.org/10.1377/hlthaff.2015.1668