Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model

@inproceedings{Pope2004RiskAO,
  title={Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model},
  author={Gregory C. Pope and John Kautter and Randall Randall P. Ellis and Arlene S. Ash and John Z. Ayanian and Lisa I. Iezzoni and Melvin J. Ingber and Jesse M. Levy and John M Robst},
  booktitle={Health care financing review},
  year={2004}
}
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. 

Citations

Publications citing this paper.
SHOWING 1-10 OF 318 CITATIONS

A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

  • International journal of integrated care
  • 2016
VIEW 5 EXCERPTS
CITES BACKGROUND
HIGHLY INFLUENCED

How Much Favorable Selection Is Left in Medicare Advantage?

VIEW 6 EXCERPTS
CITES BACKGROUND
HIGHLY INFLUENCED

Risk-Adjustment System for the Medicare Capitated ESRD Program

  • Health care financing review
  • 2006
VIEW 6 EXCERPTS
CITES BACKGROUND & METHODS
HIGHLY INFLUENCED

FILTER CITATIONS BY YEAR

2004
2019

CITATION STATISTICS

  • 22 Highly Influenced Citations

  • Averaged 27 Citations per year over the last 3 years

References

Publications referenced by this paper.
SHOWING 1-10 OF 13 REFERENCES

Internet address: http://www.cdc.gov/nchs/ about/otheract/icd9/abticd9.ht

R. P. Ellis, G. C. Pope, Iezzoni, L.I
  • 2004

Refinements to the Diagnostic Cost Group (DCG) model.

  • Inquiry : a journal of medical care organization, provision and financing
  • 1995

Similar Papers

Loading similar papers…