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Health insurers and stakeholders have expressed support for the Centers for Medicare and Medicaid Services plan to phase out risk-adjusted models over a three-year period in the 2024 Medicare Advantage Program and Part D Payment Policy . release Friday.
According to Susan Dentzer, president and CEO of America’s Physician Groups, changes to the model will begin in 2024, with tiered risk adjustments rolling out in 2026.
Susan Denzer, president and CEO of Physicians Group of America, said: “They were mostly listening.”
Insurers also expressed support for increased payouts in the 2024 Medicare Advantage and Part D rate announcements.
CMS expects Medicare Advantage Plan payments to increase 3.32% from 2023 to 2024 as a result of various changes, including risk adjustments.
This compares to the 1.03% increase in revenue proposed in the 2024 advance notice released in February.
AHIP President and CEO Matt Eyles said: “As the MA program continues to serve an increased share of Medicare-eligible Americans, it is important that the public sector and It is imperative that private markets work together to implement programs in a thoughtful, supportive, and timely manner. We’ve made strides to show strong support for a program that consistently provides affordable, high-quality care to millions of Americans.”
The Better Medicare Alliance also said it appreciates the tiered approach but remains concerned that the underlying policy remains unchanged.
Better Medicare Alliance President and CEO Mary Beth Donahue said:
Margaret A. Murray, CEO, Association for Community Available Plans, said: ACAP will closely track how this change to its risk adjustment system will affect the dual eligible beneficiaries that our plan serves and will continue to engage in constructive dialogue with CMS. We will investigate these impacts and work to mitigate the potential unintended consequences of these changes to our payment systems. About the coverage available to Medicare’s most vulnerable set of subscribers. ”
Why this matters
What CMS has proposed is a dramatic change in the risk adjustment, Denzer said.
“They’ve pushed this really quickly. They’re fully aware in their actions that it’s not going to work to bring about this degree of change,” she said. It wasn’t enough.”
The final risk-adjusted model reflects revisions that focus on conditions that increase coding variation.
An estimated 20 codes in particular were problematic, Denzer said.
“It wasn’t what was advised, but it was too fast,” she said.
the bigger trend
CMS has released technical and clinical updates to keep its MA risk-adjusted model up-to-date and improve payout accuracy.
One change led to a move to the intra-disease classification (ICD)-10 system, the coding classification system used throughout the US healthcare system since 2015, and updated data years.
CMS also said it would begin collecting improper payments made to insurance companies under Medicare Advantage. The proposed policy includes: Address problematic pre-approval practices that impede timely access to needed care. Facilitate access to critical behavioral health care. We raise the bar for quality and aim for more equitable care.
Twitter: @SusanJMorse
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Juan Nanez will provide more details in the HIMSS23 session How Access to Regional Data by Healthcare Providers Reduces Readmissions. It is scheduled for Tuesday, April 18, from 11:00 am to 11:30 am, South Wing 1st Floor, Room S104.
