Health Payer Intelligence October 12, 2017
Payers and related stakeholders must account for the consumer and policy factors that can balance risk pools and lower enrollee premiums.
– Payers have been increasingly challenged to manage the high cost of healthcare while lowering the premiums their beneficiaries pay. Creating balanced risk pools that benefit medically complex individuals while also serving healthier consumers is a key component of keeping costs under control for all parties.
Risk pools are groups of individuals across the medical complexity spectrum, which allow both private and public payers to potentially offset the cost of sicker individuals with higher medical expenses with premiums from healthier individuals with lower utilization rates.
However, if risk pools become unbalanced when there are more sick, costly beneficiaries than...
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