The Current State of Risk Adjustment Technology for Capitation

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Abstract

Risk adjustment for the purposes of making capitated payments better reflect the expected costs of medical care is a technology that is now being applied in the public and private sector. This article reviews the characteristics of many of the risk adjuster methods that have been put forward in recent years. Included are models based on diagnoses from Inpatient hospital data, and from inpatient and ambulatory data. Models for the general population, Medicaid, and Medicare are discussed. Caveats in comparing models are also presented.

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