- 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