Risk-Sharing Programs Helped Equalize Impact of Costs Among Health Insurers, AHRQ Study Finds

Issue 561
AHRQ News Now is a weekly newsletter that highlights agency research and program activities.
April 4, 2017

AHRQ Stats: Medical Care for Children

In 2014, approximately 8 percent of U.S. children younger than 18 (about 5.8 million children) were reported as not having a usual source of care. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #501: Children's Usual Source of Care: Insurance, Income, and Racial/Ethnic Disparities, 2004-2014.)

Today's Headlines:

Risk-Sharing Programs Helped Equalize Impact of Costs Among Health Insurers, AHRQ Study Finds

Federal programs designed to equalize payments for health insurance companies’ costs were "relatively well targeted" in the two years following introduction of the Affordable Care Act’s (ACA) marketplaces, according to an AHRQ study in the April issue of Health Affairs. Because the ACA prevents insurers from varying coverage based on applicants’ health status, the law includes two mechanisms to equalize the impact of differences in enrollees’ health risks. A risk-adjustment program was designed to transfer funds from plans with lower risk enrollees to plans with higher risk enrollees. In addition, the ACA’s temporary reinsurance program, in place from 2014 to 2016, partially compensated insurance plans for higher cost enrollees to provide a cushion for plans in the early years of the marketplaces. AHRQ researchers found that prior to these payments, claims (not including administrative expenses) exceeded premium revenues by $90 to $397 per enrollee per month for the 30 percent of insurers with the highest claims costs. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0 to $49 per month for the same category of insurers. The findings may shed light on how risk-sharing programs can address risk selection among insurers, the authors concluded. Access the abstract.

Coalition To Improve Diagnosis Seeks To Identify Diagnostic Safety Tools by May 1

The Coalition to Improve Diagnosis (CID) is seeking survey responses until May 1 to identify effective tools or interventions for improving diagnostic performance or reducing harm associated with diagnostic error. AHRQ, which has been a coalition partner since 2015, held a summit on diagnostic safety in 2016 and is funding research on the topic. CID comprises more than 20 professional societies and was established to bring awareness, attention and action to the problem of diagnostic error.

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Apply by May 19 for Summer TeamSTEPPS® Advanced Courses

Teams may apply now to attend a no-cost TeamSTEPPS® Advanced Course at one of the program’s regional training centers. Applications are due by May 19 for courses in July and August. TeamSTEPPS is AHRQ’s training curriculum designed to enhance patient safety through improved teamwork and communication among health care professionals. Access more information about available courses, guidelines and the application process.

Featured Case Study: New Jersey Hospital Uses AHRQ Toolkit To Reduce Catheter Use

New Jersey’s Meadowlands Hospital Medical Center used AHRQ’s Toolkit for Reducing CAUTI in Hospitals to more than double catheter-free days among patients between 2015 and 2016. The toolkit promotes limited use of catheters, urine cultures and antibiotics while encouraging best practices for catheter use and removal. Access the case study.

AHRQ in the Professional Literature

Increasing consumer engagement by tailoring a public reporting website on the quality of diabetes care: a qualitative study. Smith MA, Bednarz L, Nordby PA, et al. J Med Internet Res 2016 Dec 21;18(12):e332. Access the abstract on PubMed®.

Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region. Sohn MW, Kang H, Park JS, et al. BMJ Open Diabetes Res Care 2016 Dec 23;4(1):e000284. Access the abstract on PubMed®.

Impact of adherence to quality measures for localized prostate cancer on patient-reported health-related quality of life outcomes, patient satisfaction, and treatment-related complications. Sohn W, Resnick MJ, Greenfield S, et al. Med Care 2016 Aug;54(8):738-44. Access the abstract on PubMed®.

Massachusetts inpatient Medicaid cost response to increased Supplemental Nutrition Assistance Program benefits. Sonik RA. Am J Public Health 2016 Mar;106(3):443-8. Epub 2016 Jan 21. Access the abstract on PubMed®.

Spirometric variability in smokers: transitions in COPD diagnosis in a five-year longitudinal study. Sood A, Petersen H, Qualls C, et al. Respir Res 2016 Nov 10;17(1):147. Access the abstract on PubMed®.

Whole-exome sequencing to identify novel biological pathways associated with infertility after pelvic inflammatory disease. Taylor BD, Zheng X, Darville T, et al. Sex Transm Dis 2017 Jan;44(1):35-41. Access the abstract on PubMed®.

Diagnostic testing and hospital outcomes of children with neurologic impairment and bacterial pneumonia. Thomson J, Hall M, Berry JG, et al. J Pediatr 2016 Nov;178:156-63.e1. Epub 2016 Aug 22. Access the abstract on PubMed®.

What time is it? Adherence to antiretroviral therapy in Ethiopia. Tiruneh YM, Wilson IB. AIDS Behav 2016 Nov;20(11):2662-73. Access the abstract on PubMed®.

Contact Information

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Page last reviewed April 2017
Page originally created April 2017
Internet Citation: Risk-Sharing Programs Helped Equalize Impact of Costs Among Health Insurers, AHRQ Study Finds. Content last reviewed April 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletter/e-newsletter/561.html