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Title
An outlier pool for Medicare HMO payments.
First Author
Beebe, James C
Date of Pub
1992 Fall
Pages
59-63
Volume
14
Issue
1
Other Authors
N/A
Abstract
Medicare pays "at-risk" health maintenance organizations a prospective capitation amount that is established by the adjusted average per capita cost (AAPCC) formula for estimating the amount enrollees would have cost had they remained in the fee-for-service sector. Because the AAPCC accounts for a very small percentage of the variation in beneficiary costs, considerable research has been devoted to improving the formula. A way to improve the explained variance is to remove the most expensive beneficiaries from the AAPCC payment system and pay for them separately. This article examines one approach to a payment system that combines the AAPCC with an outlier payment mechanism.
Abstract Continued
N/A
MeSH
Capitation Fee/statistics & numerical data : Health Maintenance Organizations/economics : Insurance Pools/economics : Medicare/economics/organization & administration : Outliers, DRG/economics : Prospective Payment System/economics : Rate Setting and Review : Risk : United States
NTIS Number
PB95-123279