A new risk management paradigm for managed care.
The long-term outlook for managed care may be threatened by current capitation-rate-development methods that adjust risk for age, gender, geographic area, income level, and occupation, but not health status. Not only provider payments, but also patient access may be compromised as a result. New risk-adjustment methods that categorize patients into groups based on their current health status and anticipated disease progression allow fairer distribution of the essential components of costs to deliver healthcare services to the at-risk population, and improve upon HCFA's adjusted average per capita cost (AAPCC) rates and recently implemented principal inpatient diagnostic cost group (PIP-DCG) risk-adjustment methodology.
Kemka
J M
JM
Actuarial Sciences Associates, Inc., Somerset, New Jersey, USA. jkemka@asabenefits.com
D002204:Capitation Fee; D018450:Disease Progression; D005376:Financial Management / Q000379:methods; D006305:Health Status Indicators; D006801:Humans; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D015233:Models, Statistical; D011907:Rate Setting and Review / Q000379:methods*; D020379:Risk Adjustment / Q000379:methods*; D014481:United States