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Interactive Analysis: 2023 ACA Risk Adjustment Transfer Payment Results

Christopher Steibel

Manager, Client Advisory

As the manager of client advisory, Christopher is focused on the delivery of Pareto’s solutions as well as ongoing industry advisory to various healthcare clients.

Pooja Denchanala

As a data analyst driven by curiosity and a passion for continuous learning, Pooja thrives on exploring new methodologies and technologies. Her enthusiasm for discovering innovative approaches has led her to update and refine existing solutions, significantly enhancing product performance. By merging her analytical skills with a commitment to staying current, Pooja contributes to more effective and advanced data-driven strategies that elevate user experience and operational efficiency.

On July 22, 2024, the Department of Health and Human Services (HHS) unveiled the highly anticipated Summary Report on Risk Adjustment Transfer for the 2023 Benefit Year. This report dives into risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. 

In an effort to simplify the data and enhance understanding, Pareto quickly ingested the data provided and developed the interactive analysis below, which includes year-over-year (YOY) comparisons of state average metrics, issuer transfer payments, and high-cost risk pool payments.

Risk Adjustment Transfer Payments

In the dashboard below, you will find a range of interactive buttons at the top that will guide you through the analyses and help you find answers to key questions, including:

  1. How are state average metrics trending year-over-year?
  2. How do premium changes compare across different markets (by state)?
  3. How are high-cost risk pool payments correlated with transfer payments?
  4. How are transfer payments as a percent of premium changing in the Individual and Small Group market?
  5. What types of plans are capturing transfer payments (e.g., Nationals, Blues Plans, Provider-Sponsored)?
  6. How did transfer payments change year-over-year by issuer?

You can filter by year, state/region, metric, and/or risk pool/product (Individual or Small Group market).

Note: State average Plan Liability Risk Score (PLRS) cannot be compared YOY due to adjustments to the CMS-HHS risk adjustment model coefficients. For this reason, Pareto has applied a reduction to all prior year state average PLRS numbers allowing for a more accurate YOY comparison.

Conclusion

The above analysis summarizes HHS data to provide initial insight into the 2023 ACA risk adjustment transfer payment results. We’re dedicated to helping organizations grow, perform, and transform through professional consultancy and award-winning technology solutions.

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