Medicare Advantage Non PACE Risk Score by County

$79 / year

The dataset contains information on the non-PACE (Programs of All-Inclusive Care for the Elderly) risk scores 2010-2016. Risk scores used in the ratebooks are calculated using the model to be used in the payment year. The beneficiaries included in the state-level risk scores in this dataset are those enrolled in fee-for-service (FFS) population, who were not in hospice. For each year, the raw (not normalized) risk scores were divided by the average risk score for that year to produce risk scores below which average out to 1.0.

Complexity

Health plans that participate in the Medicare Advantage program receive monthly capitation payments for each Medicare enrollee. Each capitated payment is the product of two general parts: 1) A base rate which reflects the payment if a Medicare Advantage enrollee has the health status of the national average beneficiary, and 2) A risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiary. The purpose of the risk scores is to adjust Medicare Advantage payments so that they accurately reflect how much each Medicare Advantage enrollee would be expected to cost. Key components of the 2017 Medicare Advantage rates include: 1) Revision to the risk-adjustment model to better account for fully dual eligible beneficiaries. 2) Adjustment to certain measures within the Star Ratings program for socioeconomic status. 3) Update to the blended risk scores using 75 percent of the risk score calculated using data from the Risk Adjustment Processing System (RAPS) and 25 percent of the risk score calculated using encounter data. 4) Incentives to Medicare Advantage organizations to offer plans with lower maximum out-of-pocket limits.
The Programs of All-Inclusive Care for the Elderly (PACE) is a unique capitated managed care benefit for the frail elderly provided by a not-for-profit or public entity. The PACE program features a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with participants’ needs.

Date Created

2016-04-04

Last Modified

2018-03-30

Version

2018-03-30

Update Frequency

Annual

Temporal Coverage

2010-2016

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Non PACE Medicare Fees, Non PACE Risk Scores, Fee-for-Service Medicare Costs, Medicare Payments, Medicare Rates, FFS Rates, Medicare Risk Scores, Medicare Risk Adjustment, Advantage Payment Rates, Non-PACE Rates

Other Titles

US Counties Medicare Advantage Non PACE Risk Scores, Medicare Advantage Non PACE Risk Scores By State And County, Medicare Non PACE Adjusted Risk Scores By County

Name Description Type Constraints
County_FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
StateName of state to which the beneficiary belongsstring-
CountyName of county to which the beneficiary belongsstring-
Risk_Score_2010Medicare advantage risk score for 2010; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2011Medicare advantage risk score for 2011; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2012Medicare advantage risk score for 2012; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2013Medicare advantage risk score for 2013; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2014Medicare advantage risk score for 2014; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2015Medicare advantage risk score for 2015; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
Risk_Score_2016Medicare advantage risk score for 2016; a risk score which indicates how costly the enrollee is expected to be relative to the national average beneficiarynumberlevel : Ratio
County_FIPS_CodeStateCountyRisk_Score_2010Risk_Score_2011Risk_Score_2012Risk_Score_2013Risk_Score_2014Risk_Score_2015Risk_Score_2016
40145Puerto RicoCanovanas0.31
GuamGuam0.640.640.650.660.650.660.66
16460IowaIda1.011.000.970.960.970.960.97
16550IowaLee0.950.950.940.950.950.950.94
16800IowaSac0.970.970.960.970.940.910.87
13000IdahoAda0.900.900.900.900.900.900.91
13220IdahoGem0.830.840.840.840.840.850.85
16140IowaCass0.860.860.840.850.850.850.85
16200IowaClay0.900.900.900.910.910.940.94
16470IowaIowa0.930.940.930.930.910.930.96