title: Risk adjustment of Medicare capitation payments using the CMS-HCC model.
abstract: 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.
authors.affiliation: RTI International, Waltham, MA 02452, USA. gpope@rti.org
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Pope
authors.forename: John
authors.initials: J
authors.lastname: Kautter
authors.forename: Randall P
authors.initials: RP
authors.lastname: Ellis
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Lezzoni
authors.forename: Melvin J
authors.initials: MJ
authors.lastname: Ingber
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Levy
authors.forename: John
authors.initials: J
authors.lastname: Robst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D038801:International Classification of Diseases; D008297:Male; D020398:Medicare Part C / Q000458:organization & administration*; D008875:Middle Aged; D017146:Models, Organizational; D020379:Risk Adjustment; D014481:United States