Table 22.4 in Ch 22 of Group Insurance shows a discount factor that varies between 0.08% and 15% for category 2 which represents bonus/withhold arrangements that an insurer sets upon contracted providers.
1) It seems like this would be less risky than contractual fee payments (discounted FFS, case rates, UCR) with providers. Theoretically, these arrangements - let's say a medical home with target MLRs and bonuses for physician groups - would be designed in a way that is advantageous to the insurer and therefore less risky than Category 1 payments.
2) Those contracted physician groups could achieve bonuses that result in more risk for the insurer. I suppose that is the argument for the 0.08% to 15% range, but why would this be considered Category 2? One would think the bonuses/withhold should be Category 1, and contractual fee payments should be Category 2, to keep things in order.
1) It seems like this would be less risky than contractual fee payments (discounted FFS, case rates, UCR) with providers. Theoretically, these arrangements - let's say a medical home with target MLRs and bonuses for physician groups - would be designed in a way that is advantageous to the insurer and therefore less risky than Category 1 payments.
2) Those contracted physician groups could achieve bonuses that result in more risk for the insurer. I suppose that is the argument for the 0.08% to 15% range, but why would this be considered Category 2? One would think the bonuses/withhold should be Category 1, and contractual fee payments should be Category 2, to keep things in order.
RBC Managed Care Risk Adj. Discount Fx
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