Do Medicare Advantage plans select enrollees in higher margin clinical categories?

@article{Newhouse2013DoMA,
  title={Do Medicare Advantage plans select enrollees in higher margin clinical categories?},
  author={Joseph Newhouse and J Michael McWilliams and Mary E. Price and Jie Huang and Bruce H Fireman and John Hsu},
  journal={Journal of health economics},
  year={2013},
  volume={32 6},
  pages={
          1278-88
        }
}
The CMS-HCC risk adjustment system for Medicare Advantage (MA) plans calculates weights, which are effectively relative prices, for beneficiaries with different observable characteristics. To do so it uses the relative amounts spent per beneficiary with those characteristics in Traditional Medicare (TM). For multiple reasons one might expect relative amounts in MA to differ from TM, thereby making some beneficiaries more profitable to treat than others. Much of the difference comes from… CONTINUE READING

Citations

Publications citing this paper.
SHOWING 1-10 OF 19 CITATIONS

Explaining variations in spells of health care treatment

VIEW 3 EXCERPTS
CITES BACKGROUND & METHODS
HIGHLY INFLUENCED

Alternative evaluation metrics for risk adjustment methods.

VIEW 2 EXCERPTS
CITES BACKGROUND