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Risk adjustment of Medicare capitation payments using the CMS-HCC model
Pope, Gregory C. ; Kautter, John ; Ellis, Randall P. ; Ash, Arlene S. ; Ayanian, John Z. ; iezzoni, Lisa I. ; Ingber, Melvin J. ; Levy, Jesse M. ; Robst, John
Pope, Gregory C.
Kautter, John
Ellis, Randall P.
Ash, Arlene S.
Ayanian, John Z.
iezzoni, Lisa I.
Ingber, Melvin J.
Levy, Jesse M.
Robst, John
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Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
Document Type
Journal Article
Publication Date
2004-10-21
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
*Capitation Fee
Centers for Medicare and Medicaid Services (U.S.)
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
International Classification of Diseases
Male
Medicare Part C
Middle Aged
Models, Organizational
*Risk Adjustment
United States
Biostatistics
Epidemiology
Health Services Research
Adult
Aged
Aged, 80 and over
*Capitation Fee
Centers for Medicare and Medicaid Services (U.S.)
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
International Classification of Diseases
Male
Medicare Part C
Middle Aged
Models, Organizational
*Risk Adjustment
United States
Biostatistics
Epidemiology
Health Services Research
Subject Area
Embargo Expiration Date
Link to Full Text
Abstract
This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary payer subpopulations are discussed.
Source
Health Care Financ Rev. 2004 Summer;25(4):119-41. Link to article on publisher's site
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DOI
Permanent Link to this Item
PubMed ID
15493448