Health Affairs July 8, 2022
In two Forefront articles on September 29 and September 30, 2021, “Medicare Advantage, Direct Contracting, And the Medicare ‘Money Machine’,” Drs. Don Berwick and Rick Gilfillan argue that Medicare Advantage (MA) plans receive higher premiums relative to what the Centers for Medicare and Medicaid Services (CMS) would pay in traditional Medicare (TM). They attribute this to the incentive in MA to capture diagnoses in order to increase risk scores, and in turn premium payments, for MA plans. As a result, one of their recommendations is to eliminate the disease-based risk-adjustment hierarchical condition category (HCC) risk scoring system.
The debate that Berwick and Gilfillan triggered continued with responses by George Halvorson and Don Crane, and a further response by Berwick and...
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