Measuring Medicare Advantage risk coding, devising optimal policy

Richard Kronick, AHRQ

Medicare Advantage remains an attractive option for Medicare beneficiaries, and enrollment has increased substantially, by 66 percent in the past six years. Also increasing, it seems, is coding intensity for risk adjustments.

Will there be some Obamacare rate shock in 2015?

Robert Laszewski

Hanging around actuaries as long as I have, one of the old sayings I picked up was: "Figures don't lie, but liars figure."

Feature Video

President Obama acknowledges the technical issues with HealthCare.gov, pledging his Administration will resolve them soon and asserting that the distressed web portal is not the only way to shop for affordable health insurance available through the ACA.


Three years after launching a 750-patient Medicare Advantage collaborative care pilot, Portland, Maine-based independent physician practice NovaHealth and insurer Aetna have shown concrete results in improving care quality and reducing costs. Technology and provider-payer cooperation played a large part in the program's success.

Hospital systems buying up medical practices cite integration efforts and payment reform as a justification. Now, though, payers might rightly be concerned about where the trend can lead at local levels.

Amid a mulligan of sorts for a large state insurance exchange, an insurer with a new mission is using the old tactic of tapping brokers in a bid to vie in the big leagues.

The federal government is clamping down hard on some profit-focused patient referral and healthcare joint venture practices, although the company in question appears unfazed as it enters new forays, including some with insurers.

An established but growing player in the health insurance technology space is looking to get big and serious.

As cardiovascular disease becomes a greater risk for both older and younger Americans, there may be new grounds for steering members away from traditional diagnostics.

"Isn't that covered by ObamaCare?" Public understanding of the Affordable Care Act has not been great, with a fair amount of confusion about key provisions and benefits detected by surveys.

Trying to wean themselves off fee-for-service reimbursement, some health systems may be taking a non-committal strategy, dipping their toes in the water before deciding if they want to learn to swim. Insurers should be looking for more than that, if they can offer the right expertise.


Advertisement. Closing in 15 seconds.