Build on the steady progress in risk adjustment. Risk adjustment is a tool used to address selection bias in Medicare Advantage and other private insurance programs. The goal is to mitigate an insurer’s ability to tailor plans to attract a disproportionate share of the most profitable enrollees—healthier enrollees that consume less medical services. Every major Medicare reform proposal, based on premium support, would provide risk adjustment or significantly improve the risk-adjustment formulas or mechanisms that currently exist in the MA or Medicare Part D program. Risk adjustment could either be prospective or retrospective. Prospective risk adjustment already characterizes Medicare Advantage and Medicare Part D, where government per capita payments are adjusted by demographic factors, such as age, sex, institutional or Medicaid status, and medical conditions. Retrospective risk adjustment—back-end adjustments—would be based on new pooling arrangements, such as a risk-transfer pool. In that arrangement, health plans that attracted higher-risk or more costly patients would be cross-subsidized by plans that attracted fewer high-risk or less costly patients. The value of these types of arrangements is that they would be based on hard data and not on educated guesswork or projections. The Wyden–Ryan plan, for example, includes such an approach. The Heritage proposal would include both prospective and retrospective risk adjustment. Applying the lessons from MA’s risk-adjustment experience could mitigate the risks that only the unhealthy would be stuck in Medicare fee-for-service plans, leaving the plans’ costs to escalate and grow further away from the premium support benchmark, and thus more expensive for enrollees. Over the past decade, as Alice Rivlin and others have noted, the risk-adjustment mechanism used in Medicare Advantage has significantly improved and succeeded in reducing favorable selection in the program. In the future, with the adoption of defined-contribution financing for the entire Medicare program, one can expect further refinements and innovative approaches to adjusting government per capita payments. One particularly interesting approach has been developed by Zhou Yang, professor of economics at Emory University. Professor Yang’s proposal, to be implemented within an environment of competitive health plans, would tie Medicare payments to positive behavioral changes: Enrollees would be rewarded for enrollment in wellness or preventive-care programs that promote a healthier (and thus less costly) lifestyle.
Mercy Maricopa Integrated Care
Mercy Maricopa became the Regional Behavioral Health Authority (RBHA) for Maricopa County on April 1, 2014. We offer two health plans: Mercy Maricopa and Mercy Maricopa Advantage. Mercy Maricopa serves people who qualify for RBHA services. Mercy Maricopa Advantage serves people who qualify for RBHA services, have Medicaid, have been determined to have a serious mental illness (SMI) and have Medicare. Learn about eligibility and how to become a member.
The University of Arizona Health Plans
El 28 de febrero de 2015, The University of Arizona Health Network se incorporó con Banner Health. Banner Health comparte la responsabilidad de Maricopa Care Advantage (MCA, por sus siglas en ingles) de proporcionar un cuidado de salud excelente. Esta unión, con uno de los proveedores de mayor excelencia en el cuidado de salud en el Estado, también tiene el potencial para mejorar la calidad de servicios que los miembros de MCA reciben y mejorar el acceso en general de cuidado de salud. Pero lo más importante, la unión no tendrá repercusiones en los beneficios de cuidado de salud recibidos por los miembros y no habrá cambios en la red de proveedores del plan. MCA continuará ofreciendo el mismo nivel de calidad de atención al cliente y de servicio que ha proporcionado históricamente. Conforme sigan las negociaciones de contrato con Banner Health, nosotros lo mantendremos informado. Mientras tanto, si tiene cualquier pregunta, nos puede llamar al 1-877-874-3935 de lunes a viernes, de 8:00 a.m. a 8:00 p.m. TTY 711
Aetna Medicaid Administrators LLC
With an aging population, rising health care costs and strained budgets, quality health care is an urgent national priority. Aetna Medicaid Administrators LLC (Aetna Medicaid) is an industry leader in coordinating care and controlling costs.
Easy Choice Health Plan (HMO)
If you are looking for a Medicare Advantage Prescription Drug Plan that not only allows for “one stop service” for all your physician, hospital and prescription drug needs, but also provides additional, non Medicare covered benefits, at virtually no cost to you, you’ve come to the right place! Easy Choice Health Plan (HMO) is a federally approved Medicare Advantage Prescription Drug (MAPD) and Special Needs Plan (SNP) designed to provide medical and prescription drug coverage for qualifying individuals in Los Angeles, Alameda, Fresno, San Diego, Santa Clara, Stanislaus, Riverside, Orange, San Joaquin, and San Bernardino counties, California.