How does risk selection respond to risk adjustment? New evidence from the Medicare Advantage Program

Jason Brown, Mark Duggan, Ilyana Kuziemko, William Woolston

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

To combat adverse selection, governments increasingly base payments to health plans and providers on enrollees' scores from risk-adjustment formulae. In 2004, Medicare began to risk-adjust capitation payments to private Medicare Advantage (MA) plans to reduce selection-driven overpayments. But because the variance of medical costs increases with the predicted mean, incentivizing enrollment of individuals with higher scores can increase the scope for enrolling "overpriced" individuals with costs significantly below the formula's prediction. Indeed, after risk adjustment, MA plans enrolled individuals with higher scores but lower costs conditional on their score. We find no evidence that overpayments were on net reduced.

Original languageEnglish (US)
Pages (from-to)3335-3364
Number of pages30
JournalAmerican Economic Review
Volume104
Issue number10
DOIs
StatePublished - Oct 1 2014

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Medicare
Risk selection
Risk adjustment
Payment
Costs
Enrollment
Adverse selection
Prediction
Capitation
Government
Health plans
Medical costs

All Science Journal Classification (ASJC) codes

  • Economics and Econometrics

Cite this

Brown, Jason ; Duggan, Mark ; Kuziemko, Ilyana ; Woolston, William. / How does risk selection respond to risk adjustment? New evidence from the Medicare Advantage Program. In: American Economic Review. 2014 ; Vol. 104, No. 10. pp. 3335-3364.
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How does risk selection respond to risk adjustment? New evidence from the Medicare Advantage Program. / Brown, Jason; Duggan, Mark; Kuziemko, Ilyana; Woolston, William.

In: American Economic Review, Vol. 104, No. 10, 01.10.2014, p. 3335-3364.

Research output: Contribution to journalArticle

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