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Explore the 2021 ACA Risk Adjustment Transfer Payment Results

Austin Bostock

Director, Business Development

Austin is the Director of Business Development, focused on the implementation and delivery of Pareto’s solutions as well as ongoing industry advisory to various healthcare clients. His combined engineering and business backgrounds allows him to bring an analytical approach to solving problems and supporting revenue management improvement activities for clients.

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Tom Field

Senior Data Analyst

As a Senior Data Analyst, Tom uses big data and complex analytical tools to extract informative and compelling insights for innovation initiatives. With a background in data engineering, Artificial Intelligence, and data science, he helps design and build our end-to-end solutions – all the while providing backend support and data quality assurance to ensure accurate analysis and reporting.

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On June 30, 2022, the Department of Health and Human Services (HHS) released the Summary Report on Risk Adjustment Transfer for the 2020 Benefit Year, which outlines risk adjustment transfer payments by issuer and state for the Affordable Care Act (ACA) market. To help health plans understand the results, Pareto has quickly ingested the data and developed the interactive analysis below with year-over-year (YOY) comparisons into state average metrics (including average monthly premium), issuer transfer payments and high-cost risk pool payments.

Risk Adjustment Transfer Payments

In the dashboard, use the buttons across the top to navigate the analyses answering key questions, such as:

  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?

Within each view, filter by year, state/region, metric, and/or risk pool/product (Individual or Small Group market) in the drop-downs at the top.

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 in the analysis below, allowing for a more accurate YOY comparison.

Conclusion

The above analysis summarizes the HHS data to provide initial insight into the 2021 ACA risk adjustment transfer payment results.

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