The HHS-HCC Risk Adjustment Model for Individual and Small Group Markets under the Affordable Care Act

• DOI: 10.5600/mmrr.004.03.a03
• Publication Date: 2014-09-05T19:46:27Z
• Authors: John Kautter; Gregory Pope; Sara Freeman; Lindsey Patterson; Michael Cohen; Patricia Keenan
• Keywords: Economic risk; Specific risk

Beginning in 2014, individuals and small businesses are able to purchase private health insurance through competitive Marketplaces. The Affordable Care Act (ACA) provides for a program of risk adjustment the individual group markets 2014 as Marketplaces implemented new market reforms take effect. purpose is lessen or eliminate influence selection on premiums that plans charge. methodology includes model transfer formula. This article second three this issue Review describe Department Health Human Services (HHS) focuses model. In our first companion article, we discuss key issues choices developing methodology. present model, which named HHS-Hierarchical Condition Categories (HHS-HCC) We summarize HHS-HCC diagnostic classification, element Then data methods, results, evaluation presented. Fifteen separate models developed. For each age (adult, child, infant), developed cost sharing level (platinum, gold, silver, bronze metal levels, well catastrophic plans). Evaluation shows good predictive accuracy, both groups. Lastly, examples how output used calculate scores, an input into Our third paper describes