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Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs.

Gifford GA, Edwards KR, Knutson DJ - Health Care Financ Rev (2004)

Bottom Line: This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues.Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment.Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model.

View Article: PubMed Central - PubMed

ABSTRACT
This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model.

No MeSH data available.


Trends in Health Plan Risk Scores, by Health Plan: MinnesotaCare Medical Assistance, April 1998-June 2001
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC4194869&req=5

f3-hcfr-26-2-021: Trends in Health Plan Risk Scores, by Health Plan: MinnesotaCare Medical Assistance, April 1998-June 2001

Mentions: Figure 1 shows aggregate health plan risk scores for each program across participating health plans. Figures 2 and 3 show health plan risk scores for each of the 10 quarterly risk assessments used to risk adjust capitation payments from January 2000-June 2002 for the PMAP and PMNC programs (Table 3 contains source data). Rates for the first quarter of CY 2000 were adjusted by the health plan risk scores based on the period April 1998-March 1999. Then, rates for the second quarter of CY 2000 were adjusted by health plan risk scores from the period July 1998-June 1999, and so on.


Health-Based Capitation Risk Adjustment in Minnesota Public Health Care Programs.

Gifford GA, Edwards KR, Knutson DJ - Health Care Financ Rev (2004)

Trends in Health Plan Risk Scores, by Health Plan: MinnesotaCare Medical Assistance, April 1998-June 2001
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4194869&req=5

f3-hcfr-26-2-021: Trends in Health Plan Risk Scores, by Health Plan: MinnesotaCare Medical Assistance, April 1998-June 2001
Mentions: Figure 1 shows aggregate health plan risk scores for each program across participating health plans. Figures 2 and 3 show health plan risk scores for each of the 10 quarterly risk assessments used to risk adjust capitation payments from January 2000-June 2002 for the PMAP and PMNC programs (Table 3 contains source data). Rates for the first quarter of CY 2000 were adjusted by the health plan risk scores based on the period April 1998-March 1999. Then, rates for the second quarter of CY 2000 were adjusted by health plan risk scores from the period July 1998-June 1999, and so on.

Bottom Line: This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues.Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment.Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model.

View Article: PubMed Central - PubMed

ABSTRACT
This article documents the history and implementation of health-based capitation risk adjustment in Minnesota public health care programs, and identifies key implementation issues. Capitation payments in these programs are risk adjusted using an historical, health plan risk score, based on concurrent risk assessment. Phased implementation of capitation risk adjustment for these programs began January 1, 2000. Minnesota's experience with capitation risk adjustment suggests that: (1) implementation can accelerate encounter data submission, (2) administrative decisions made during implementation can create issues that impact payment model performance, and (3) changes in diagnosis data management during implementation may require changes to the payment model.

No MeSH data available.