The development of a risk-adjusted capitation payment system: the Maryland Medicaid model

Published: October 1, 1998
Category: Bibliography > Papers
Authors: Abrams C, Collins AM, Fakhraei H, Folkemer JG, Lieberman R, Trapnell GR, Tucker AM, Weiner JP
Countries: United States
Language: null
Types: Care Management, Finance/Budgeting
Settings: Health Plan

J Ambul Care Manage 21:29-52.

School of Public Health, Johns Hopkins University, Baltimore, MD, USA

This article describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients. This simulation suggests that the new payment model will help adjust for adverse or favorable selection. The article is intended for a wide audience, including state and national policy makers concerned with the design of managed care Medicaid programs and actuaries, analysts, and researchers involved in the design and implementation of risk-adjusted capitation payment systems.

PMID: 10387436

Capitation,Payment,Payment Schedules,United States,Ambulatory Care/classifications,Ambulatory Care/economics,Diagnosis-Related Groups/economics,Health Policy,Maryland,State Health Plans/economics

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