miércoles, 26 de octubre de 2016

Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage. - PubMed - NCBI

Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage. - PubMed - NCBI



 2016 Jun 1;35(6):1022-8. doi: 10.1377/hlthaff.2015.1668.

Risk-Adjustment SimulationPlans May Have Incentives To Distort Mental Health And Substance Use Coverage.

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 healthplan 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 healthand substance use diagnoses used in Medicare Part D risk adjustment is one potential policy step toward addressing this problem in the Marketplaces.

KEYWORDS:

Adverse Selection; Marketplace; Mental Health/Substance Abuse; Risk Adjustment

PMID:
 
27269018
 
PMCID:
 
PMC5027954
 
DOI:
 
10.1377/hlthaff.2015.1668

[PubMed - in process] 
Free PMC Article