Managed Care

 

Risk Pays Off Under HCFA's New Medicare Scheme

MANAGED CARE April 1999. © MediMedia USA
News and Commentary

Risk Pays Off Under HCFA's New Medicare Scheme

MANAGED CARE April 1999. ©1999 Stezzi Communications

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.

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015