Tag Archives: Brad Piper

Medicare Advantage risk score considerations

Risk scores are a crucial area of focus for successful Medicare Advantage (MA) plans because changes in risk scores directly affect plan revenue. However, risk scores are complex and are influenced by many factors, which can confuse those who are new to MA risk score development. This article by Milliman’s Hillary Millican and Brad Piper offers perspective on the following questions related to MA risk scores.

• What time period of diagnoses supports risk scores?
• When are revenue payments made?
• Who submits diagnoses used to create risk scores?
• Why is member retention critical for the success of a Medicare Advantage organization (MAO)?

Payment reform will impact Medicare Advantage

The Patient Protection and Affordable Care Act (PPACA) will lead to significant changes in the Medicare Advantage (MA) market. But because the act’s payment reform effects and specific MA plan circumstances will vary by area, each MA organization will have to evaluate its star rating and the payment reform details in its service area to determine the particular impact that the PPACA changes will have on its future revenue.

Read the paper here.