{"id":4092,"date":"2022-09-14T00:03:58","date_gmt":"2022-09-13T18:33:58","guid":{"rendered":"https:\/\/v-etico.com\/us\/?p=4092"},"modified":"2022-09-20T16:47:02","modified_gmt":"2022-09-20T11:17:02","slug":"how-risk-adjustment-overhaul-affects-your-insurance-needs","status":"publish","type":"post","link":"http:\/\/v-etico.com\/us\/how-risk-adjustment-overhaul-affects-your-insurance-needs\/","title":{"rendered":"The Truth Behind the Risk Adjustment Overhaul and How It Affects Your Insurance Needs"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"4092\" class=\"elementor elementor-4092\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-329027e elementor-section-full_width dt-navbar elementor-section-stretched ops-section she-header-yes 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<\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ecd7ca3 elementor-section-height-min-height elementor-section-full_width elementor-section-height-default elementor-section-items-middle\" data-id=\"ecd7ca3\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-a14f67c\" data-id=\"a14f67c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-97fb23b\" data-id=\"97fb23b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-01d6226 elementor-widget elementor-widget-heading\" data-id=\"01d6226\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">The Truth Behind the Risk Adjustment Overhaul and How It Affects Your Insurance Needs<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-5278fff\" data-id=\"5278fff\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-268d3d8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"268d3d8\" data-element_type=\"section\" data-settings=\"{&quot;ekit_has_onepagescroll_dot&quot;:&quot;yes&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-193fa87\" data-id=\"193fa87\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-575edad elementor-widget elementor-widget-text-editor\" data-id=\"575edad\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\"><h2 style=\"text-align: justify;\">Introduction<\/h2><p style=\"text-align: justify;\"><strong>Medicare Advantage plans<\/strong> are starting to see their <strong>risk adjustment payments<\/strong> cut in the wake of the CMS overhauls. \u00a0The plans that treat the sickest beneficiaries &#8211; those with high-cost claims &#8211; have recently seen their risk adjustment payments reduced, creating a financial incentive for them to offer fewer generous benefits to attract healthier enrolees. \u00a0In order to attract more people who are healthy and less expensive than those they&#8217;re currently serving, insurers may have an incentive to drop coverage altogether from some beneficiaries so they can reduce costs by avoiding paying for expensive care.<\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-4209 size-full\" title=\"How Risk Adjustment Overhaul Affects Your Insurance Needs\" src=\"http:\/\/v-etico.com\/us\/wp-content\/uploads\/2022\/09\/How-Risk-Adjustment-Overhaul-Affects-Your-Insurance-Needs.jpg\" alt=\"How Risk Adjustment Overhaul Affects Your Insurance Needs\" width=\"700\" height=\"300\" \/><\/p><h3 style=\"text-align: justify;\">CMS is considering two options it says will boost payments and reduce the need for plans to &#8220;cherry-pick&#8221; healthier enrolees.<\/h3><p style=\"text-align: justify;\">Medicare Advantage plans are being forced to cut back on the benefits they offer or risk losing money.<\/p><p style=\"text-align: justify;\">Medicare Advantage plans are increasingly realizing that their clients want <strong>lower premiums, higher deductibles,<\/strong> and <strong>fewer generous benefits<\/strong> <strong>than in the past<\/strong>. \u00a0CMS is proposing two options that would boost payments and reduce the need for plans to &#8220;cherry-pick&#8221; healthier enrolees.<\/p><ul style=\"text-align: justify;\"><li>The first option would increase payments based on how much a plan costs relative to Medicaid&#8217;s average (or median) patient cost per day of care.<\/li><li>The second option would require all Medicare Advantage HMOs with at least one high-risk member to see an annual increase in their risk adjustment payment rate equal to 1% of their total premiums earned during the previous year &#8211; a 50% increase from current levels!<\/li><\/ul><h3 style=\"text-align: justify;\">While insurers say the changes will cause premiums of riskier members to increase and premiums of healthier people to decrease, CMS compares its overhauls with the status quo.<\/h3><p style=\"text-align: justify;\">The first, which CMS calls a &#8220;risk adjustment overhaul,&#8221; involves using a new method of <strong>computing payments based on health status, risk scores, and other factors<\/strong>. \u00a0In this scenario, insurers who enrol higher-risk patients would see their costs go down while plans with healthier members would be paid more by CMS \u2014 thus reducing their incentive to cherry-pick healthy enrolees.<\/p><p style=\"text-align: justify;\">The second option uses what&#8217;s called an \u201c<strong>aggregate risk index<\/strong>\u201d <strong>(ARI)<\/strong>. \u00a0This would calculate how much money each plan needs based on its total membership population using information like age and gender demographics, as well as individual diagnoses or procedures performed over time rather than just one snapshot in time like under current law does now.<\/p><h3 style=\"text-align: justify;\">Insurers are upset with CMS rebalancing how risk-adjustment payments are made.<\/h3><p style=\"text-align: justify;\">In a nutshell, <strong>CMS is overhauling the risk adjustment program in Medicare Advantage plans<\/strong>.<\/p><p style=\"text-align: justify;\">This is an update of a previous report on the risk adjustment program published in June 2014. The original report, titled: &#8220;Medicare Advantage Risk Adjustment Program: Addressing Inequities and <strong>Improving Transparency<\/strong>&#8220;, was prepared by the Kaiser Family Foundation&#8217;s <strong>Health Care Innovation Project (HCIP)<\/strong>. \u00a0It examined how much money insurers are receiving from taxpayers under this multi-billion-dollar program and made recommendations for improving its effectiveness as well as increasing transparency about how it works.<\/p><p style=\"text-align: justify;\">The risk adjustment plan is an important part of the Affordable Care Act. \u00a0The goal of this plan is to make sure that insurers are not penalized for taking on high-risk patients. \u00a0This system has been criticized for not being fair because it doesn&#8217;t take into account the different needs and costs in each state. \u00a0This can lead to some states paying more than others, which could cause some insurers to leave the market.<\/p><h4 style=\"text-align: justify;\">Conclusion<\/h4><p style=\"text-align: justify;\">The Medicare Advantage program has long been in the crosshairs of insurers, and it seems that the risk adjustment overhauls are just another reason for those companies to be worried about what&#8217;s coming next. \u00a0The lawmakers behind these changes have made it clear that they are not interested in hearing any arguments from insurers who might want to preserve certain aspects of their business model. \u00a0And with an increasingly fragile budget outlook, it&#8217;s hard to see how this kind of behaviour might not create a great deal of uncertainty for the entire industry as a whole &#8211; especially if there are further rounds of cuts coming down the road.<\/p><p style=\"text-align: justify;\">For more updates about the Medicare and insurance, <a href=\"https:\/\/v-etico.com\/us\/contact-us\/\">contact us online<\/a>\u00a0or call us at\u00a0<a href=\"tel:+1-307-368-8003\">+1-307-368-8003<\/a>\u00a0or Email us at\u00a0<span data-sheets-value=\"{\" data-sheets-userformat=\"{\"><strong>alexa@v-etico.com<\/strong>.<\/span><\/p><p style=\"text-align: justify;\"><strong>Danielle Ezra<\/strong><\/p><p style=\"text-align: justify;\">Executive \u2013 Social Media Marketing<\/p><p style=\"text-align: justify;\">V-Etico Services LLC<\/p><p style=\"text-align: justify;\"><a href=\"https:\/\/v-etico.com\/us\/\">www.v-etico.com<\/a><\/p><p style=\"text-align: justify;\"><strong>Phone:<\/strong>\u00a01 (307) 368-8003<\/p><p style=\"text-align: justify;\"><strong>E-Mail:<\/strong>\u00a0alexa@v-etico.com<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>&#8220;Risk adjustment overhaul,&#8221; involves using a new method of computing payments based on health status.<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"elementor_canvas","format":"standard","meta":{"footnotes":""},"categories":[19],"tags":[25,26],"class_list":["post-4092","post","type-post","status-publish","format-standard","hentry","category-healthcare","tag-medicare","tag-risk-adjustment-overhaul"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Risk Adjustment Overhaul and How It Affects Your Insurance Needs<\/title>\n<meta name=\"description\" content=\"&quot;Risk adjustment overhaul,&quot; involves using a new method of computing payments based on health status, risk scores, and other factors.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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