在医疗保险中,差异化编码带来的收入的保险公司级估计是医疗保险的优势
Richard Kronick1, F Michael Chua2, Ramona Krauss3
1Herbert Wertheim School of Public Health, La Jolla, California (R.Kronick).
医疗保险优势计划的诊断编码强度高于传统医疗保险,导致数十亿美元的额外支付. 这种编码变化对保险公司的收入和支付改革战略产生了重大影响.
科学领域:
- 卫生经济学 卫生经济学
- 卫生政策分析 卫生政策分析
- 医疗编码系统 医学编码系统
背景情况:
- 与传统医疗保险 (TM) 相比,Medicare Advantage (MA) 计划的诊断编码强度更高.
- 在不同的MA计划中,编码强度存在显著差异.
研究的目的:
- 量化MA保险公司之间编码强度的差异.
- 为了估计每个MA保险公司由于差异化编码而产生的额外收入.
主要方法:
- 分析MA和TM之间的不同编码模式.
- 估计差异化编码对合同级风险分数和收入的影响.
主要成果:
- 在2021年,MA风险得分平均比TM高0.19分. 联合健康集团的风险评分比TM高0.28分.
- 据估计,MA计划在2021年获得了约330亿美元的额外支付,其中UnitedHealth获得了139亿美元 (42%).
- 凯撒永久的编码强度仅略高于TM.
结论:
- 不同编码显著增加了MA计划的收入,保险公司之间存在巨大的差异.
- 针对差异化编码的支付政策改革将根据保险公司产生不同的影响.
更多相关视频
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
06:46Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
Published on: September 27, 2024
相关概念视频
Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Kaplan-Meier Approach
Actuarial Approach
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
Comparing the Survival Analysis of Two or More Groups
