Risk Pays Off Under HCFA's New Medicare Scheme


The Health Care Financing Administration has taken steps to make Medicare+Choice more attractive to health plans in low-paying rural counties, while encouraging them to enroll or keep sicker patients. HCFA will boost the payment floor by nearly 6 percent in 2000, while instituting a blending formula that pushes health plan capitation rates in many low-to-moderate-payment counties even higher. Additionally, HCFA is beginning a risk-adjustment scheme that pays Medicare+Choice plans more for treating sicker patients.

Beginning in 2000, the payment floor for plans in rural counties will rise from $380 to $402. Additionally, fewer markets will be at this level; in 63 percent of the nation's counties, plans will benefit from a formula that blends local payment rates with the higher national average. Some counties will see significant increases; for instance, health plans in Fresno County, Calif., will see a 13-percent jump in per-member, per-month payments. Medicare HMOs in the highest-cost areas, such as Miami and Philadelphia, will receive incremental 2-percent increases.

The risk-adjustment system, meanwhile, can increase payment to an HMO for a single enrollee as much as sixfold, depending on age, severity of illness, and Medicaid eligibility.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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