HCPro.com: Capitation Rates and Data

Each issue of this monthly newsletter is jam-packed with PMPM rates, benchmark capitation and comparative information-from determining appropriate physician panel sizes and stop-loss attachment points to evaluating your PMPM rates and withholds.

To view the entire newsletter issue, click the “View Entire Issue” link below

June 2008 (Volume 13, Issue 6)	view entire issue

Evaluate 2009 payment rates for MA plans
Health plans and providers that hold Medicare Advantage (MA) contracts breathed a sigh of relief in April when the Centers for Medicare & Medicaid Services (CMS) disclosed that it will not reduce payments to some MA plans in 2009 to offset increased coding intensity. In its 45-day advance notice of preliminary changes in 2009 payment rates, issued February 22, CMS had proposed to adjust payments to offset the effects of increased coding intensity in approximately 25% of plans whose risk scores are increasing more than twice as fast as Medicare FFS.

Use predictive modeling to improve case management
Once the exclusive purview of health plans, predictive modeling has made significant strides in bridging the gap among healthcare constituents. Today, predictive modeling can be used by capitated provider organizations not only to analyze costs and PMPM rates, but also to increase the efficiency of care management. One pernicious problem that drives healthcare costs is the inadequacy of historical data, such as prior cost or inpatient utilization, to accurately forecast members at high risk of future hospitalization.

Other recently-published articles from Capitation Rates and Data:

Do the math before taking capitation risk for vaccines

Guided Care plan reduces costs for chronically ill seniors

Coordinated care benefits children with special needs

Social media provide cost-effective route to patient care

Coordinated care program cuts costs for members with chronic illness

Dartmouth Atlas: Overtreatment still common

PROMETHEUS payment model aims to top capitation

Managed Medicare may help seniors avoid preventable hospitalizations through better coordination of care

Weigh the balance between healthcare quality and costs

Benchmark your cap rates against this profitable IPA

Examine underlying community trends as one factor in the cost of care

Use predictive modeling to improve case management

Evaluate 2009 payment rates for MA plans

Mine your data to target high-risk members

Drug cost data suggest patient copays, compliance linked

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