EXHIBIT 4. Predictive ratios for individuals with mental health and substance use diagnoses who are recognized and unrecognized by the Marketplace model.

SOURCE Authors’ analysis of sample data. NOTES Diagnoses are based on Clinical Classification Software (CCS) categories, as in Exhibit 3. Recognized and unrecognized individuals (described in the text) are mutually exclusive. Predictive ratios measure how well the risk-adjustment system compensates health insurance plans for a subgroup by taking the ratio of average plan liabilities (total plan payments minus [compensated] predicted payments based on the Health and Human Services–Hierarchical Condition Category [HHS-HCC] model to average actual total payments for each subgroup of individuals. The exhibit does not include CCS categories with less than 1 percent of individuals or less than 1 percent of total spending: developmental disorders, disorders usually diagnosed in infancy/childhood/adolescence, impulse control disorders, personality disorders, schizophrenia and other psychotic disorders, and suicide and intentional self-inflicted injury.