title: The development of a risk-adjusted capitation payment system: the Maryland Medicaid model.
abstract: This article describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients. This simulation suggests that the new payment model will help adjust for adverse or favorable selection. The article is intended for a wide audience, including state and national policy makers concerned with the design of managed care Medicaid programs and actuaries, analysts, and researchers involved in the design and implementation of risk-adjusted capitation payment systems.
authors.affiliation: School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Weiner
authors.forename: A M
authors.initials: AM
authors.lastname: Tucker
authors.forename: A M
authors.initials: AM
authors.lastname: Collins
authors.forename: H
authors.initials: H
authors.lastname: Fakhraei
authors.forename: R
authors.initials: R
authors.lastname: Lieberman
authors.forename: C
authors.initials: C
authors.lastname: Abrams
authors.forename: G R
authors.initials: GR
authors.lastname: Trapnell
authors.forename: J G
authors.initials: JG
authors.lastname: Folkemer
mesh_terms: D000553:Ambulatory Care / Q000145:classification / Q000191:economics; D002204:Capitation Fee; D003953:Diagnosis-Related Groups / Q000191:economics; D006291:Health Policy; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D008396:Maryland; D008484:Medicaid / Q000191:economics*; D020379:Risk Adjustment / Q000379:methods*; D013221:State Health Plans / Q000191:economics; D014481:United States