Diagnosis-Based Risk Adjustment for Medicare Capitation Payments
- 1 January 1996
- journal article
- Vol. 17 (3) , 101-128
Abstract
Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula.Keywords
This publication has 25 references indexed in Scilit:
- Variation in office-based quality. A claims-based profile of care provided to Medicare patients with diabetesPublished by American Medical Association (AMA) ,1995
- Refinements to the Diagnostic Cost Group (DCG) model.1995
- Rates of Avoidable Hospitalization by Insurance Status in Massachusetts and MarylandJAMA, 1992
- Alternative geographic adjustments in Medicare payment to health maintenance organizations1992
- Using chronic disease risk factors to adjust Medicare capitation payments1992
- Using health indicators in calculating the AAPCC (adjusted average per capita cost).1989
- Adjusting capitation rates using objective health measures and prior utilization1989
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- Rate adjusters for Medicare under capitation1986
- The use and costs of Medicare services in the last 2 years of life1984