Prevention and Dynamic Risk Adjustment
Adjusting Medicaid Managed Care Payments for Changes in Health Status
"Risk-adjustment methods have an inherent structural flaw that rewards
preventable deterioration in enrollee health status and improved coding
of disease burden", this is the key statement in Fuller et al. article. The answer they provide is the introduction of an additional payment adjustment according to changes in health status for similar mix of enrollees. The payment adjustment being proposed is based on changes in aggregate relative payment weights for all enrollees avoiding any individual adjustment.
This is a concrete application of the initial dynamic risk adjustment proposal that Eggleston et al. made in 2007. They suggested a two step payment system: a conventional risk adjustment (for variations in
population health outside the provider’s control) and an additional one related to prevention efforts.
There is still a lot to learn about it. Let's keep an eye on this crucial topic.
PS. Have a look at Commonwealth Fund anouncement: "Our initiative recognizes that a wide range of factors influence
providers’ choices, beyond financial rewards or penalties, including
intrinsic motivation and medical professionalism, organizational
influences, and policy" (see Box)
