Risk Adjustment of Medicare Capitation Payments using the CMS-HCC Model
This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model’s principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary payer sub populations are discussed.
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Citation / Publisher Attribution
Health Care Financing Review, v. 25, issue 4, p. 119–141
Scholar Commons Citation
Pope, Gregory C.; Kautter, John; Ellis, Randall P.; Ash, Arlene S.; Ayanian, John Z.; Lezzoni, Lisa I.; Ingber, Melvin J.; Levy, Jesse M.; and Robst, John, "Risk Adjustment of Medicare Capitation Payments using the CMS-HCC Model" (2004). Mental Health Law & Policy Faculty Publications. 75.