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

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 pe...

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Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CENTERS for MEDICARE & MEDICAID SERVICES 2004
Materias:
Research Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194896/
https://www.ncbi.nlm.nih.gov/pubmed/15493448
Descripción
Sumario: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.

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