Plan payments in Medicare Advantage (MA), the Affordable Care Act (ACA) exchanges, and new global payment models such as ACOs must be adjusted for variation in the health status of enrollees. This process is broadly known as risk adjustment, which includes both traditional regression-based risk adjustment methods and other tools that could address the problem of individuals in different risk strata systematically enrolling in different plans.
The Risk Adjustment area focuses on projects supporting development of better risk adjustment methodologies and tools.
Accomplishments and Collaborations
Ongoing Projects
- Risk Adjustment Redesign (mcGuire) This project seeks to fundamentally redesign the current risk adjustment model.
- Improving Sampling Techniques for Medicare Advantage Plan Payment Methodology with Machine Learning (Rose) This project intends to improve risk adjustment for MA plan payment by developing machine learning-based matching methods to draw an improved sample of subjects for estimating risk adjustment.
Other Activities
- McGuire is the second American to be invited to join the Risk Adjustment Network (RAN), an international organization of scholars working on risk adjustment.
- Advising and collaborating with policy makers and academics in Switzerland and the Netherlands.
- After background work on Marketplace payment reform in connection with ASPE, Dr. McGuire is collaborating with researchers from the Center for Consumer Information and Insurance Oversight (CCIIO) regarding alternatives to reinsurance.
Selected Papers and Publications
- Rose S. A Machine Learning Framework for Plan Payment Risk Adjustment. Health Serv Res. Published online: Feb 19, 2016.
- Douven R, McGuire TG, McWilliams JM. Avoiding Unintended Incentives in ACO Payment Models. Health Affairs. 2015;34(1):143-149.
- Layton T, McGuire TG, Sinaiko A. Risk Corridors and Reinsurance in Health Insurance Marketplaces: Insurance for Insurers. Am J Health Econ. 2016;2(1):66-95.
Geruso M, McGuire TG. Tradeoffs in the Design of Health Plan Payment Systems: Power, Fit and Balance. J Health Econ. 2016;47:1-19.