Findings Emphasize Need for Increased Transparency In Medicare Advantage Operations
“Our research highlights the pressing need for increased transparency in Medicare Advantage.
The practice of strategic cross-subsidization we’ve identified could deepen socioeconomic inequalities in healthcare access and outcomes, underscoring the critical need for strict oversight of capitation payment systems.”
Strategic cross-subsidization is expressly forbidden by law in the U.S. due to its significant impact on risk selection in capitation programs, where health plans use targeted benefit designs to attract more profitable enrollees.
The study, led by Turgay Ayer in collaboration with co-authors Zhaowei She from Singapore Management University, Bilal Gokpinar from University College London, and Danny Hughes from Arizona State University, analyzed a large commercial insurance database containing claims data from over 2 million Medicare Advantage (MA) enrollees.
This is what she further explained, “For each one-point increase in a patient’s risk score, the annual ‘spending-cost difference’ (the gap between what MA plans spend on a patient and the payments they receive) drops by more than $9,000,” she said.
Check further:
Zhaowei She et al, Strategic Cross-Subsidization in Healthcare Capitation Programs: Evidence from Medicare Advantage, Manufacturing & Service Operations Management (2024). DOI: 10.1287/msom.2023.0637
Citation:
Findings call for transparency in Medicare Advantage operations (2024, October 8)
retrieved 8 October 2024
from https://medicalxpress.com/news/2024-10-transparency-medicare-advantage.html