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Health-based capitation risk adjustment in Minnesota public health care programs

Health Care Financ Rev 26:21-41.

Gregory A. Gifford and Kevan R. Edwards are with the Minnesota Department of Health. David J. Knutson is with the Park Nicollet Institute.

This article documents the history and  implementation of health-based capitation  risk adjustment in Minnesota public health  care programs, and identifies key implementation  issues. Capitation payments in  these programs are risk adjusted using an  historical, health plan risk score, based on  concurrent risk assessment. Phased implementation  of capitation risk adjustment for  these programs began January 1, 2000.  Minnesota’s experience with capitation risk  adjustment suggests that: (1) implementation  can accelerate encounter data submission,  (2) administrative decisions made  during implementation can create issues  that impact payment model performance,  and (3) changes in diagnosis data management  during implementation may  require changes to the payment model.

Predictive Risk Modeling,Payment,Capitation,United States,