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Researchers: Medicare Can Improve Chronic Condition Risk Adjustments

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The Medicare program could do a better job of reflecting the cost of treating patients with multiple chronic conditions in health plan payment formulas, researchers say.

Researchers from Johns Hopkins and George Washington University make that argument in a report published in the March issue of the journal Medical Care.

Medicare program members try to pay plans more when the plans are caring for high-risk Medicare enrollees. The researchers found that adding more health history data to the Medicare risk adjustment formula seems to make the formula more accurate.

More accurate pricing could encourage plans to offer patients with chronic health problems better care and keep them from developing expensive new health problems, rather than simply trying to attract healthier enrollees, according to Robb Cohen, chief government affairs officer at XLHealth Corp., Baltimore, a company that runs plans that serve enrollees with serious health problems.

Improving the quality of care for the high-risk enrollees could help hold down overall Medicare program claims costs, according to Cohen, who is listed as one of the study co-authors

- Allison Bell

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