Risk Adjustment for the Medicare program: lessons learned from research and demonstrations.
The Balanced Budget Act (BBA) of 1997 requires numerous changes in Medicare. Medicare's managed care program has been reinvented as "Medicare + Choice," offering an expanded range of delivery system options for beneficiaries and a schedule of payment changes that will dramatically affect managed care plans. Preceding some of these BBA-legislated changes to Medicare were years of research and demonstrations. Risk-adjusted payment in the Medicare + Choice program, which is mandated for implementation in 2000, is one example of a longstanding developmental initiative. This paper provides a brief overview of risk adjustment-related research and demonstration activities carried out by the Health Care Financing Administration (HCFA) since the 1980s, and describes a possible technical approach for the implementation of risk-adjusted Medicare managed care payments in 2000.
Greenwald
L M
LM
Division of Payment Research, Research and Evaluation Group, Baltimore, MD 21244, USA.
Esposito
A
A
Ingber
M J
MJ
Levy
J M
JM
D000368:Aged; D002204:Capitation Fee; D005544:Forecasting; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D005102:Health Expenditures; D006302:Health Services Research; D006801:Humans; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D006278:Medicare / Q000458:organization & administration*; D017146:Models, Organizational; D010865:Pilot Projects; D012308:Risk Management / Q000331:legislation & jurisprudence; D014481:United States