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- Title
Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model.
- Authors
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
- 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.
- Subjects
MEDICARE; HEALTH insurance; CAPITATION fees (Medical care); MEDICAL fees
- Publication
Health Care Financing Review, 2004, Vol 25, Issue 4, p119
- ISSN
0195-8631
- Publication type
Article