Risk Adjustment of Medicare Capitation Payments Using the CMS-HCC Model

By G. Pope, J. Kautter, R. Ellis, A. Ash, J. Ayanian, L. Iezzoni, M. Ingber, J. Levy, John M Robst. Health Care Financing Review, 2004

879 citations recorded by the source corpus.

This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary-payer subpopulations are discussed.

View Paper: https://www.semanticscholar.org/paper/9e6d598350301c06d2ab0a736ceec4bd32f7b570

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Citations in the corpus

• Diagnoses and Timing of 30-Day Readmissions after Hospitalization For Heart Failure, Acute Myocardial Infarction, or Pneumonia (2013, unknown): “Each of the 189 CC groups is structured around a reasonably well-specified disease or medical condition.(17) However, because nearly 90% of the 189 CC groups each accounted for less than 1% of all readmissions, we consolidated related diagnoses into a shorter list of 30 modified CCs to make data pre”
• Predicting Risk of Suicide Attempts Over Time Through Machine Learning (2017, methodology): “Multiple CMS-HCC diagnoses (with names matching the 2014 release in publicly available data sets; Pope et al., 2006) were important in predicting nonfatal suicide attempts.”