了解社会风险因素调整对星级评级的影响
Anagha Tolpadi1, Melony E Sorbero, Maria DeYoreo
1RAND Corporation, 1776 Main St, Santa Monica, CA 90401.
The American journal of managed care
|January 3, 2024
概括
分类调整指数 (CAI) 适度影响医疗保险优势星级评级,主要有利于为高风险人群提供服务的合同. 这种调整可以防止低估表现,并阻止避免社会风险的入学者.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
- 质量测量 质量测量
背景情况:
- 医疗保险优势 (MA) 星级评级可能不利于服务于社会风险受注册者的计划.
- 由于社会经济地位和残疾的差异,测量偏差可能会发生.
- 实施了分类调整指数 (CAI) 来解决这种偏差.
研究的目的:
- 评估CAI对MA星级评级的影响.
- 确定CAI最受影响的许可证合同类型.
- 评估CAI对质量奖金支付和绩效指标的影响.
主要方法:
- 关于MA合同的观察性研究 (2017-2020年).
- 调整后与未调整后星级评级的比较.
- 分析按入学者的社会经济地位 (低收入补贴/双重资格[LIS/DE]) 和残疾分层.
主要成果:
- 总体而言,CAI的影响是温和的,其中3.2%-14.9%的合同出现了半星变化.
- 具有高LIS/DE或残疾人入学率的合同经历了星级评级上升调整 (7.7%-32.3%).
- 2020年,26.0%的高需求合同有资格获得CAI的质量奖金支付.
结论:
- 该CAI主要受益于高比例LIS/DE或残疾学生的MA合同.
- 这种调整确保了对这些合同的更公平的绩效评估.
- 它减少了MA计划避免社会风险患者群体的激励.
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