منابع مشابه
Integrating risk adjustment and enrollee premiums in health plan payment.
In two important health policy contexts - private plans in Medicare and the new state-run "Exchanges" created as part of the Affordable Care Act (ACA) - plan payments come from two sources: risk-adjusted payments from a Regulator and premiums charged to individual enrollees. This paper derives principles for integrating risk-adjusted payments and premium policy in individual health insurance ma...
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action subsuming make spaghetti and make fettucini (make pesto and make marinara). Edge labels like h=; 1; 2i represent between two actions a and b represent the fact that the rst argument of a is identical to the second argument of b. Computing the join of G1 and G2 then consists of nding action nodes sharing a common abstraction and identifying temporal and strcutural relations common to both...
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This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a genera...
متن کاملInsights from Machine Learning for Plan Recognition
This paper explores the bene ts of adapting techniques from inductive concept learning to plan recognition. A powerful notion in concept learning is characterizing inductive systems by their bias, i.e. the implicit assumptions which justify the conclusions an inductive system produces. We present a spectrum of possible biases for plan recognition. We evaluate these biases based on how accuratel...
متن کاملDiagnosis-Based Risk Adjustment for Medicare Prescription Drug Plan Payments
The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) created Medicare Part D, a voluntary prescription drug benefit program. The benefit is a government subsidized prescription drug benefit within Medicare. This article focuses on the development of the prescription drug risk-adjustment model used to adjust payments to reflect the health status of plan enrollees.
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ژورنال
عنوان ژورنال: Health Services Research
سال: 2016
ISSN: 0017-9124
DOI: 10.1111/1475-6773.12464