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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,
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