Risk-Adjustment Simulation: Plans May Have Incentives To Distort Mental Health And Substance Use Coverage.

ABSTRACT: Under the Affordable Care Act, the risk-adjustment program is designed to compensate health plans for enrolling people with poorer health status so that plans compete on cost and quality rather than the avoidance of high-cost individuals. This study examined health plan incentives to limit covered services for mental health and substance use disorders under the risk-adjustment system used in the health insurance Marketplaces. Through a simulation of the program on a population constructed to reflect Marketplace enrollees, we analyzed the cost consequences for plans enrolling people with mental health and substance use disorders. Our assessment points to systematic underpayment to plans for people with these diagnoses. We document how Marketplace risk adjustment does not remove incentives f

SUBMITTER: Montz E 

PROVIDER: S-EPMC5027954 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature