The goal of the HHS risk adjustment program is to compensate health insurance plans for differences in enrollee health mix so that plan premiums reflect differences in scope of coverage and other plan factors, but not differences in health status. This allows fairer competition in the market and equalizes risk so that health plans can focus on competing on benefit design, quality efficiency and value rather than solely on price.
“We welcome the opportunity to work closely with HHS to ensure the risk adjustment program is as accurate and equitable as possible,” said J.
The proposed rule by HHS introduces several significant changes to make the risk adjustment program more effective at pooling risks. One recommendation is to incorporate prescription drugs in the risk adjustment model, which would lead to a more comprehensive picture of the severity of an illness and fill in gaps where diagnoses data may be missing from medical claims. Another change would be the consideration of better estimate techniques. These techniques would more accurately reflect the predicted risk of low-cost enrollees, which are under-accounted for in the current model. Lastly, the removal of administrative and other non-medical related costs from the risk transfer formula would eliminate the transfer of risk adjustment dollars that are unrelated to enrollee’s health.
Molina currently serves nearly 600,000 Marketplace members across nine states in which the company already offers other government-sponsored programs, such as
Juan José Orellana, 562-435-3666