Taking health status into account when setting capitation rates: A comparison of risk-adjustment methods

JAMA

Volumn 276, Issue 16, 1996, Pages 1316-1321

  Fowles, Jinnet B ^a   Weiher, Jonathan P ^b   Knutson, David ^a   Fowler, Elizabeth ^a   Tucker, Anthony M ^b   Ireland, Marjorie ^a,c  

^a HealthSystem Minnesota   (United States)

^b JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^c UNIVERSITY OF MINNESOTA MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; FEE; FINANCE; FUNCTIONAL ASSESSMENT; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH STATUS; PATIENT SELECTION; PREDICTION; PRIORITY JOURNAL; RISK ASSESSMENT;

EID: 0029909069     PISSN: 00987484     EISSN: None     Source Type: Journal    
DOI: 10.1001/jama.276.16.1316     Document Type: Article

References (34)

1. Gruber LR, Shadle M, Polich CL. From movement to industry: the growth of HMOs. Health Aff (Millwood). 1988;7:197-208.
2. Wallack SS. Managed care: practice, pitfalls, and potential. Health Care Financ Rev. 1991;suppl:27-34.
3. Group Health Association of America. National Directory of HMO8: 1995 Edition. Washington, DC: Group Health Association of America - American Managed Care Review Association; 1995.
4. National Survey of Employer-Sponsored Health Plans. New York, NY: A Foster Higgins Inc; 1996.
5. Emmons DW, Simon CJ. Physician Marketplace Report: Recent Trends in Managed Care. Chicago, Ill: American Medical Association; 1993.
6. Gold MR, Hurley R, Lake T, Ensor T, Berenson R. A national survey of the arrangements managed-care plans make with physicians. N Engl J Med. 1995;333:1678-1683.
7. Robinson JC, Casalino LP. The growth of medical groups paid through capitation in California. N Engl J Med. 1995;333:1684-1837.
8. Woolhandler S, Himmelstein DU. Extreme risk - the new corporate proposition for physicians. N Engl J Med. 1995;333:1706-1708.
9. Iglehart JK. Physicians and the growth of managed care. N Engl J Med. 1994;331:1167-1171.
10. Newhouse JP. Patients at risk: health reform and risk adjustment. Health Aff (Millwood). 1994; 13:132-146.
11. Neff JM, Anderson G. Protecting children with chronic illness in a competitive marketplace. JAMA. 1995;274:1866-1869.
12. Physician Payment Review Commission. Annual Report to Congress. Washington, DC: Physician Payment Review Commission; 1994.
13. Hornbrook MC, Goodman MJ. Health plan case mix: definition, measurement, and use. In: Scheffler RM, Rossiter LF, eds. Advances in Health Economics and Health Services Research. Greenwich, Conn: JAI Press; 1991;12:111-148.
14. Robinson JC, Luft HS, Gardner LB, Morrison EM. A method for risk-adjusting employer contributions to competing health insurance plans. Inquiry. 1991;28:107-116.
15. Shewry S, Hunt S, Ramey J, Bertko J. Risk adjustment: the missing piece of market competition. Health Aff (Millwood). 1996;15:171-181.
16. Wetzell S. Consumer clout. Minn Med. 1996; 79:15-19.
17. Holahan J, Coughlin T, Ku L, Lipson DJ, Rajan S. Insuring the poor through Section 1115 Medicaid waivers. Health Aff (Millwood). 1995;14:199-216.
18. Salem-Schatz S, Moore G, Rucker M, Pearson SD. The case for case-mix adjustment in practice profiling: when good apples look bad. JAMA. 1994; 272:871-874.
19. Iezzoni LI. Dimensions of risk. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes. Ann Arbor, Mich: Health Administration Press; 1994:29-118.
20. Starfield B, Weiner J, Mumford L, Steinwachs D. Ambulatory Care Groups: a categorization of diagnoses for research and management. Health Serv Res. 1991;26:53-74.
21. Weiner J, Parente S, Garnick D, Fowles J, Lawthers AG, Palmer RH. Variation in office-based quality: a claims-based profile of care provided to Medicare patients with diabetes. JAMA. 1995;273: 1503-1508.
22. Epstein AM, Cumella EJ. Capitation payment: using predictors of medical utilization to adjust rates. Health Care Financ Rev. 1988;10:51-69.
23. Fowles JB, Weiner JP, Knutson D. A Comparison of Alternative Approaches to Risk Measurement: Final Report to Physician Payment Review Commission. Minneapolis, Minn: Park Nicollet Medical Foundation; 1994. Nicollet Medical Foundation grant 93-G07.
24. Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care. 1988; 26:724-732.
25. McHorney CA, Ware JE, Lu JF, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), III: tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40-66.
26. McHorney CA, Ware JE, Rogers W, Raczek AE, Lu JF. The validity and precision of MOS short- and long-form health status scales and Dart-mouth COOP charts: results from the Medical Outcomes Study. Med Care. 1992;30(5 suppl):MS253-MS265.
27. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36), II: psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247-263.
28. Ware JE, with Snow KK, Kosinski M, Gandek B. SF-36 Health Survey: Manual & Interpretation Guide. Boston, Mass: The Health Institute, New England Medical Center; 1993.
29. Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36), I: conceptual framework and item selection. Med Care. 1992;30: 473-483.
30. Weiner JP, Starfield BH, Steinwachs DM, Mumford L. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care. 1991;29:452-472.
31. Weiner JP, Dobson A, Maxwell SL, Coleman K, Starfield BH, Anderson GF. Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ Rev. 1996;17: 77-99.
32. Efron B, Gong GA. A leisurely look at the bootstrap, the jackknife, and cross-validation. Am Stat. 1983;37:36-48.
33. Newhouse JP, Manning WG, Keeler EB, Sloss EM. Adjusting capitation rates using objective health measures and prior utilization. Health Care Financ Rev. 1989;10:41-54.
34. Welch HG, Black WC, Fisher ES. Case-mix adjustment: making bad apples look good. JAMA. 1995;273:772-773.