Risk adjustment for dually eligible beneficiaries using long-term care

Health Care Financing Review

Volumn 20, Issue 2, 1998, Pages 71-90

  McCall, Nelda ^a   Korb, Jodi ^a  

^a Laguna Research Associates   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCURACY; ADULT; AGE DISTRIBUTION; AGED; CALIBRATION; COMORBIDITY; CONTROLLED STUDY; DEMOGRAPHY; DIAGNOSTIC TEST; EXPERIMENTAL MODEL; FEMALE; HEALTH CARE COST; HEALTH CARE FINANCING; HEALTH STATUS; HUMAN; HUMAN EXPERIMENT; LONG TERM CARE; MALE; MEDICARE; PATIENT CODING; PREDICTION; REVIEW; RISK ASSESSMENT; UNITED STATES;

EID: 0032418896     PISSN: 01958631     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (26)

1. Ash, A, Porell, E, Gruenberg, L, et al.: Adjusting Medicare Capitation Payments Using Prior Hospitalization Data. Health Care Financing Review 10(4):17-29, Summer 1989.
2. Booth, M., Fralich, J., and Saucier, P.: Integration of Acute and Long-Term Care for Dually Eligible Beneficiaries through Managed Care. College Park, MD: University of Maryland Center on Aging, 1997.
3. Dunn, D., Rosenblatt, A., Taira, D., et al.: A Comparative Analysis of Methods of Health Risk Assessment. SOA Monograph M-HB96-1. Schaumburg, IL Society of Actuaries, October 1996.
4. DxCG, Inc.: Guide to the Diagnostic Cost Groups (DCGs) and DxCG Software: Release 3, SAS Version. Waltham, MA: DxCG, Inc., April 1998.
5. Ellis, R., and Ash, A.: Refinements to the Diagnostic Cost Group (DCG) Model. Inquiry 32(4):418-429, Winter 1995/96.
6. Ellis, R., Pope, G., Iezzoni, L., et al.: Diagnosis-Based Risk Adjustment for Medicare Capitation Payments. Health Care Financing Review 17(3):101-128, Spring 1996a.
7. Ellis, R., Pope, G., Iezzoni, L, et al.: Diagnostic Cost Group (DCG) and Hierarchical Coexisting Conditions (HCC) Models for Medicare Risk Adjustment Volume I: Final Report. Waltham, MA: Health Economics Research, April 26, 1996b.
8. Feder, J.: Medicare/Medicaid Dual Eligibles: Fiscal & Social Responsibility for Vulnerable Populations. Washington, DC: The Kaiser Commission on the Future of Medicaid, May 1997.
9. Greenwald, L, Esposito, A., Ingber, M.J., and Levy, J.M.: Risk Adjustment for the Medicare Program: Lessons Learned from Research and Demonstrations. Inquiry 35 (2): 193-209, Summer 1998.
10. Gruenberg, L., Kaganova, E., and Hornbrook, M.: Improving the AAPCC with Health-Status Measures from the MCBS. Health Care Financing Review 17(3):59-75, Spring 1996.
11. Health Care Financing Administration: A Profile of Dually Eligible Beneficiaries. Washington, DC: Health Care Financing Administration, March 1997.
12. Kaye, N., and Fralich, J.: Collection and Use of Data: State-Operated Managed Care Programs for Dual Eligibles. College Park, MD: University of Maryland Center on Aging, 1998.
13. Kronick, R., Dreyfus, T., Lee, L, and Zhou, Z.: Diagnostic Risk Adjustment for Medicaid: The Disability Payment System. Health Care Financing Review 17(3):7-33, Spring 1996.
14. McCall, N.: Lessons from Arizona's Medicaid Managed Care Program. Health Affairs 16(4):194-199, July/August 1997.
15. Medicare Payment Advisory Commission: Report to the Congress: Medicare Payment Policy, Volume1, Recommendations. Washington, DC. March 1998.
16. Meiners, M.: Medicare/Medicaid Integration Program Grantee Highlights. Internet address: http://www.inform.umd.edu/aging. University of Maryland Center on Aging, October 8, 1998.
17. Newhouse, J.: Patients at Risk: Health Reform and Risk Adjustment. Health Affairs 13(1):132-146, Spring 1994.
18. Physician Payment Review Commission: Annual Report to Congress. Washington, DC. 1997.
19. Pope, G., Adamache, K.W., Walsh, E.G., and Khandker, R.W.: Evaluating Alternative Risk Adjusters for Medicare. Health Care Financing Review 20(2): 109-129, Winter, 1998.
20. Pope, G., Ellis, R, Liu, C.E, et al.: Revised Diagnostic Cost Group (DCG)/Hierarchical Coexisting Conditions (HCC) Models for Medicare Risk Adjustment: Final Report. Waltham, MA: Health Economics Research, Inc., February 6, 1998b.
21. Starfield, B., Weiner, J., Mumford, L., and Steinwachs, D.: Ambulatory Care Groups: A Categorization of Diagnoses for Research and Management. Health Services Research 26(1):59-68, April 1991.
22. Swartz, K: Risk Selection and Medicare + Choice: Beware. Inquiry 35(2):101-103, Summer 1998.
23. Weiner, J., Starfield, B., Steinwachs, D., and Mumford, L.: Development and Application of a Population-Oriented Measure of Ambulatory Care Case-Mix. Medical Care 29(5):452-472, May 1991.
24. Weiner, J., Dobson, A, Maxwell, S.L., et al.: Risk-Adjusted Medicare Capitation Rates Using Ambulatory and Inpatient Diagnoses. Health Care Financing Review 17(3):77-99, Spring 1996.
25. Wilkin, J., McCall, N., Wade, A., and Wrightson, C.W.: Capitating Long-Term Care Medicaid Beneficiaries: More or Less Costly than Traditional Medicaid. Discussion Paper 97-3. San Francisco: Laguna Research Associates, January 1997.
26. Wrightson, C.W.: Method of Setting Capitation Payments. Chapter 4 in Evaluation of Arizona's Health Care Cost Containment System Demonstration, Fourth Implementation and Operation Report San Francisco: Laguna Research Associates, October 1994.