IDEAS home Printed from https://ideas.repec.org/a/kap/hcarem/v3y2000i2p159-169.html
   My bibliography  Save this article

Risk adjustment of capitation payments to behavioral health care carve-outs: How well do existing methodologies account for psychiatric disability?

Author

Listed:
  • Susan Ettner
  • Richard Frank
  • Tami Mark
  • Mark Smith

Abstract

This study used 1994–1995 administrative data from a large public employer to examine the viability of commercial risk adjustment systems for setting capitation payments to competing behavioral health care “carve-outs”. The ability of Hierarchical Condition Categories and Adjusted Diagnostic Groups to predict psychiatric expenditures was improved by controlling separately for psychiatric disability. However, even the best models underpredicted expenditures of patients with psychiatric disability by 15%. Relative to full capitation, “mixed” payment systems and soft capitation reduce the ability of carve-outs to earn disproportionate profits by enrolling healthy patients and avoiding sick ones, yet also diminish incentives for cost containment. Copyright Kluwer Academic Publishers 2000

Suggested Citation

  • Susan Ettner & Richard Frank & Tami Mark & Mark Smith, 2000. "Risk adjustment of capitation payments to behavioral health care carve-outs: How well do existing methodologies account for psychiatric disability?," Health Care Management Science, Springer, vol. 3(2), pages 159-169, February.
  • Handle: RePEc:kap:hcarem:v:3:y:2000:i:2:p:159-169
    DOI: 10.1023/A:1019033105715
    as

    Download full text from publisher

    File URL: http://hdl.handle.net/10.1023/A:1019033105715
    Download Restriction: Access to full text is restricted to subscribers.

    File URL: https://libkey.io/10.1023/A:1019033105715?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Tami L. Mark & Ronald J. Ozminkowski & Adele Kirk & Susan L. Ettner & John Drabek, 2003. "Risk Adjustment for People with Chronic Conditions in Private Sector Health Plans," Medical Decision Making, , vol. 23(5), pages 387-405, September.
    2. John Robst, 2009. "Development of a Medicaid Behavioral Health Case-Mix Model," Evaluation Review, , vol. 33(6), pages 519-538, December.
    3. Raghavan, Ramesh, 2010. "Using risk adjustment approaches in child welfare performance measurement: Applications and insights from health and mental health settings," Children and Youth Services Review, Elsevier, vol. 32(1), pages 103-112, January.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:kap:hcarem:v:3:y:2000:i:2:p:159-169. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.