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Discretionary Hospital Use and Diagnostic Risk Adjustment of Medicare HMO Capitation Rates

Article Abstract:

Medicare HMOs have been successful in controlling costs by reducing discretionary hospitalizations. The health maintenance organization industry is worried that using a diagnostic risk adjustment model based solely on diagnoses from controlling costs will penalize Medicare HMOs.

Author: Porell, Frank W., Gruenberg, Leonard
Publisher: Blue Cross and Blue Shield of the Rochester Area, Inc.
Publication Name: Inquiry
Subject: Health care industry
ISSN: 0046-9580
Year: 2000
HEALTH SERVICES

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PACE and the Medicare+Choice Risk-Adjusted Payment Model

Article Abstract:

This study examines the impact of the Medicare cost payment model on the Program of All-Inclusive Care for the Elderly (PACE).

Author: Gruenberg, Leonard, Temkin-Greener, Helena, Meiners, Mark R.
Publisher: Blue Cross and Blue Shield of the Rochester Area, Inc.
Publication Name: Inquiry
Subject: Health care industry
ISSN: 0046-9580
Year: 2001
Research, Medicare

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The effects of reinsurance in financing children's health care

Article Abstract:

The advantages of awarding reinsurance under State Children's Health Insurance Program, which enhances financial scenario of health plan groups, are presented.

Author: Shenkman, Elizabeth
Publisher: Blue Cross and Blue Shield of the Rochester Area, Inc.
Publication Name: Inquiry
Subject: Health care industry
ISSN: 0046-9580
Year: 2006
Legal issues & crime, Government regulation (cont), Financial management, Government regulation, INSURANCE CARRIERS, Reinsurance, Reinsurance Carriers, Legal/Government Regulation, Hospital and medical service plans, Children, Usage, Laws, regulations and rules, Managed care plans (Medical care), Insurance, Company financing

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Subjects list: United States, Finance, Health maintenance organizations
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