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April 25 2016

AMGA Comments on CMS Risk Adjustment Discussion PaperEncourages CMS to Consider Socioeconomic and Sociodemographic Factors

Newswise — Alexandria, VA –AMGA on April 22 submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its discussion paper concerning proposals to modify the risk adjustment methodology for individual and small group health insurance plans offered on state health insurance marketplaces that were created under the Affordable Care Act (ACA). In comments to CMS, AMGA supported the idea of factoring partial year enrollees, who may have higher healthcare costs, into the risk adjustment methodology. AMGA also recommended that CMS consider socioeconomic and sociodemographic factors as part of its efforts to improve risk adjustment for plans offered on the ACA marketplaces. “Research indicates there is a relationship between socioeconomic status, race and ethnicity, and healthcare status and outcomes,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “To accurately account for the health mix of plan enrollees, these factors should be part of a risk adjustment methodology.”AMGA also agreed with CMS that patient prescription drug use and high-cost enrollees are appropriate factors to consider when revising the risk adjustment methodology. Read AMGA’s comments.

About AMGAAMGA is a 501(c)(6) trade association representing medical groups, health systems, and other organized systems of care, including some of the nation's largest, most prestigious integrated delivery systems. AMGA is a leading voice in advocating for efficient, team-based, and accountable care. AMGA members encompass all models of organized systems of care in the healthcare industry, including: physician-owned, independent group practices, integrated delivery systems, hospital-affiliated medical groups, independent practice associations (IPAs), academic and faculty practices, accountable care organizations, and high-performing health systems. Approximately 177,000 physicians practice in AMGA member organizations, providing healthcare services for 133 million patients (approximately one in three Americans). Headquartered in Alexandria, Virginia, AMGA is the strategic partner for these organizations, providing a comprehensive package of benefits, including political advocacy, educational and networking programs, publications, benchmarking data services, and financial and operations assistance.