Fierce Healthcare November 9, 2023
Financial struggles at Bright Health Group and Friday Health Plans have raised concerns about how well the Affordable Care Act’s (ACA’s) risk adjustment program is working, especially whether it’s unfairly harming smaller insurers.
However, a new analysis backed by the Blue Cross Blue Shield Association and conducted by Oliver Wyman aims to dispel these fears. For one, the study examining 2021 risk adjustment data found that by and large, the funds were moving from payers with low claims to those with high claims.
The goal of the program is to make it easier for insurers to participate on the ACA exchanges by distributing funds from payers covering fewer high-cost enrollees to those that are covering larger numbers of high-cost patients....
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