Statement of ACAP CEO Margaret A. Murray on Risk Adjustment in Medicare Advantage
FOR IMMEDIATE RELEASE: October 11, 2022
FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515
STATEMENT OF ACAP CEO MARGARET A. MURRAY ON RISK ADJUSTMENT IN MEDICARE ADVANTAGE
WASHINGTON – Margaret A. Murray, Chief Executive Officer of the Association for Community Affiliated Plans (ACAP), issued the following statement about risk adjustment in the Medicare Advantage program:
“ACAP-member Safety Net Health Plans exist to serve the most challenging Medicare Advantage beneficiaries: people who live with complex or chronic conditions, who have unmet social needs, who need to get by with lower incomes and fewer resources.
“These are the people whom the risk adjustment system is meant to serve. Risk adjustment is here to assure that health plans are accurately paid for the intensity of care that their member mix requires.
“Safety Net Health Plans depend on the risk adjustment system to be accurate to serve patients effectively and efficiently. Safety Net Health Plans have higher risk scores not because of a robust internal risk adjustment program, but because their members are sicker and more complex. ACAP-member Dual Eligible Special Needs Plans, which serve people eligible for both Medicare and Medicaid, spend more of their Medicare payments on medical expenses and patient claims, and at the same time tend to offer their services at lower cost compared with similar plans that are not ACAP members.
“Delivering effective, efficient care on narrow margins demands a robust, effective risk adjustment system that levels the playing field for companies large and small. Any reforms to the system must keep care for people with high levels of medical need in mind.”
ACAP represents 74 health plans, which collectively provide health coverage to more than 20 million people. Safety Net Health Plans serve their members through Medicaid, Medicare, the Children’s Health Insurance Program (CHIP), the Marketplace and other publicly sponsored health programs. For more information, visit www.communityplans.net.
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