Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses.
Part of a special section on advances in financing managed care. The writers discuss two new diagnosis-oriented methodologies for setting risk-adjusted capitation rates for managed care plans contracting with Medicare. These risk-adjuster models predict the future medical expenses of aged Medicare...
| Publicado en: | Health Care Financing Review Vol. 17; pp. 77 - 100 |
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| Autores principales: | , , |
| Formato: | Artículo |
| Publicado: |
HCFA ORDS Publications
Spring 1996
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=510407688&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 510407688 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 01958631 HCF jtl: Health Care Financing Review issn: 01958631 maglogo: N pubinfo: dt: Spring 1996 vid: 17 pid: 187 pub: HCFA ORDS Publications artinfo: ui: 510407688 ppf: 77 ppct: 23 formats: fmt: @attributes: type: T tig: atl: Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. aug: au: Weiner, Jonathan P. Dobson, Allen Maxwell, Stephanie L. su: Managed care programs Medical care financing Medicare Capitation fees (Medical care) sug: subj: Managed care programs Medical care financing Medicare Capitation fees (Medical care) ab: Part of a special section on advances in financing managed care. The writers discuss two new diagnosis-oriented methodologies for setting risk-adjusted capitation rates for managed care plans contracting with Medicare. These risk-adjuster models predict the future medical expenses of aged Medicare enrollees based on demographic factors and diagnostic information, and they employ the ambulatory care group algorithm to classify ambulatory diagnoses. The models are far more accurate at predicting expenditures than is the adjusted average per capita cost payment method. It is concluded that these models have considerable potential to improve current methods of calculating risk-adjusted, capitated premiums for health maintenance organizations and other managed care organizations. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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