How to outsmart biases in health plan claims data.
Before negotiating your next contract, heed this expert advice for reducing risk when setting PMPM rates and case rates using frequently biased and incomplete HMO historical data. Here are 8 tips for using HMO-provided data, plus some benchmark utilization projections for commercial and Medicare populations.
D019985:Benchmarking; D015982:Bias; D002204:Capitation Fee; D003284:Contract Services / Q000191:economics; D019468:Disease Management; D005544:Forecasting; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007344:Insurance Claim Reporting; D011907:Rate Setting and Review / Q000379:methods; D012308:Risk Management; D014481:United States