摘要:

Risk adjustment for the purposes of making capitated payments better reflect the expected costs of medical care is a technology that is now being applied in the public and private sector. This article reviews the characteristics of many of the risk adjuster methods that have been put forward in recent years. Included are models based on diagnoses from Inpatient hospital data, and from inpatient and ambulatory data. Models for the general population, Medicaid, and Medicare are discussed. Caveats in comparing models are also presented.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients. This simulation suggests that the new payment model will help adjust for adverse or favorable selection. The article is intended for a wide audience, including state and national policy makers concerned with the design of managed care Medicaid programs and actuaries, analysts, and researchers Involved in the design and implementation of risk-adjusted capitation payment systems.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The relationship between spirituality and health Is an emerging area of study. However, spirituality assessment Instruments with clinical utility for busy health care practices are lacking. The article describes research directed at developing and validating brief pictorial measures of spirituality as instruments to measure the relationship between reported spirituality and health. The instruments presented are patterned after the Dartmouth Medical School Primary Care Cooperative (COOP) charts. The charts also provide a nonthreatening way to enhance communication between patients and physicians In this Important area.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The discount factor applied to payments for second and subsequent ambulatory procedures in a payment system based on ambulatory patient groups (APGs) is important in determining the financial incentives of the system and the adequacy of the payment rates. A1995 empirical study of data from all ambulatory surgery cases done in acute general hospitals in Maryland suggests that the incremental charges associated with an APG when it is a second procedure APG are about 24% of the charges that are Incurred when the APG Is the only procedure APG in an encounter. For the third procedure APG, the percentage drops to 16%. This 24% factor is much lower than the discount factor generally used in APG payment systems. The article presents APG-adjusted charges by payer to show differences in resource use by payer. These results will be useful for organizations developing APG-based payment systems for ambulatory surgery or desiring to use APGs for benchmarking purposes.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Pharmacy data are a potential source of information on the health risks of members in a managed care organization (MCO). Reasons why these data can serve as a basis for case mix measurement of MCO populations are reviewed. Several pharmacy-based case mix measurement systems (CDS, KPARx) are summarized. Applications of pharmacy-based case mix systems for profiling of primary physician panels in an MCO are discussed and Illustrated with several examples.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID