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Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS.
Health Care Financ Rev. 2001 Winter; 23(2):53-68.HC

Abstract

Managed care organizations (MCOs) may be incurring financial losses from persons with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) (PWHA). This study developed a statistical model to examine which specific comorbidities are important contributors to the variations in health care costs of PWHA. Individuals were classified into cost groups to simulate biased selection in MCOs. Capitation payments for various cost groups under different methodologies were compared. The statistical model closely matched payments with the actual costs of care. Capitation payments for HIV/AIDS enrollees based on this model will better protect MCOs than the traditional risk-adjustment methods.

Authors+Show Affiliations

Center for Health Program Development and Management, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA. fakhraei@chpdm.umbc.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

12500338

Citation

Fakhraei, S H., et al. "Comorbidity-based Payment Methodology for Medicaid Enrollees With HIV/AIDS." Health Care Financing Review, vol. 23, no. 2, 2001, pp. 53-68.
Fakhraei SH, Kaelin JJ, Conviser R. Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS. Health Care Financ Rev. 2001;23(2):53-68.
Fakhraei, S. H., Kaelin, J. J., & Conviser, R. (2001). Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS. Health Care Financing Review, 23(2), 53-68.
Fakhraei SH, Kaelin JJ, Conviser R. Comorbidity-based Payment Methodology for Medicaid Enrollees With HIV/AIDS. Health Care Financ Rev. 2001;23(2):53-68. PubMed PMID: 12500338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS. AU - Fakhraei,S H, AU - Kaelin,J J, AU - Conviser,R, PY - 2002/12/26/pubmed PY - 2003/1/14/medline PY - 2002/12/26/entrez SP - 53 EP - 68 JF - Health care financing review JO - Health Care Financ Rev VL - 23 IS - 2 N2 - Managed care organizations (MCOs) may be incurring financial losses from persons with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) (PWHA). This study developed a statistical model to examine which specific comorbidities are important contributors to the variations in health care costs of PWHA. Individuals were classified into cost groups to simulate biased selection in MCOs. Capitation payments for various cost groups under different methodologies were compared. The statistical model closely matched payments with the actual costs of care. Capitation payments for HIV/AIDS enrollees based on this model will better protect MCOs than the traditional risk-adjustment methods. SN - 0195-8631 UR - https://www.unboundmedicine.com/medline/citation/12500338/Comorbidity_based_payment_methodology_for_Medicaid_enrollees_with_HIV/AIDS_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/12500338/ DB - PRIME DP - Unbound Medicine ER -