HCFO is one of RWJF’s longest-running programs and continues to identify ways to best meet its goal of informing policy and practice. Recently, HCFO launched a three-part series designed to convene the research, policy and practice communities to explore current, unchartered issues. These moderated discussions focused on questions for which data and experience were nonexistent or limited, but for which more and better evidence was needed to make informed decisions. The structure of these three events stimulated candid, in-depth discussion drawn out by expert moderators. HCFO’s reputation as a trusted, objective resource facilitated the gathering of experts, including academic researchers, federal and state policymakers, policy analysts, financial analysts, providers, insurers, regulators and others. The program’s emphasis on policy relevance and broad approach to meeting the needs of research users are hallmarks that will continue to guide HCFO’s work.
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MLR & Market Destabilization
Participants discussed the medical loss ratio standard in the individual insurance market and provisions within ACA for addressing the potential for market destabilization. See brief at “Recognizing Destabilization in the Individual Health Insurance Market.”
Pricing Insurance in the Current Market
Participants discussed how the interaction of multiple provisions of the ACA (rate review, MLR requirements, rating changes, risk adjustment, reinsurance and risk corridors) would affect how insurers were likely to price their products in a dynamic market environment. See brief at “Considerations Related to Pricing Individual and Small Group Health Insurance under Health Reform.”
Medicare’s Physician Value Modifier
Participants discussed the potential functioning and implementation of Medicare’s new Value-Based Physician Payment Modifier and related methodological issues. See report at “Medicare’s Value-Based, Physician Payment Modifier: Improving the Quality and Efficiency of Medical Care.”