Skip to Main Content
Title
Risk adjustment for health plans disproportionately enrolling frail Medicare beneficiaries
First Author
Riley, Gerald F
Date of Pub
2000 Spring
Pages
135-148
Volume
21
Issue
3
Other Authors
N/A
Abstract
There is concern about the adequacy of diagnosis-based risk adjusters for paying health plans that disproportionately enroll frail Medicare beneficiaries. The Medicare Current Beneficiary Survey (MCBS) was used to examine the ability of two risk-adjustment models to predict Medicare costs for groups defined by institutional status and difficulty with activities of daily living (ADLs). Both models underpredicted average costs for non-institutionalized frail beneficiaries; however, the models slightly overpredicted expenses for most frail individuals and severely underpredicted for a minority. Further refinements are needed if diagnosis-based models are used to pay plans that disproportionately enroll frail beneficiaries.
Abstract Continued
N/A
MeSH
Frail Elderly : Health Expenditures : Insurance Selection Bias : Activities of Daily Living : Diagnosis-Related Groups : Fee-for-Service Plans : Health Care Financing Administration : Health Maintenance Organizations : Medicare : Risk Factors : United States
NTIS Number
N/A