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Guidance for Healthcare Providers and Purchasers

Leading healthcare data analytics insights:

Policy Implications in Managing Risk under Bundled Payment

Submitted by jonpearce on Mon, 2012-07-09 17:08

Under episode-based bundled payment systems, a provider contacting organization is paid a fixed amount for all care required by patients who meet the definition of the episode.  Since no definition of episodes results in a totally homogeneous group of patients, cost of individual patients vary, and therefore the contacting organization is subject to random variations in its average per-patient cost depending on which patients are included in its episodes. As bundled payment models evolve, two different methods of managing these types of variations appear to have emerged.

"The Return of Capitation - Preparing for Population-Based Health Care" in July HFM

Submitted by jonpearce on Mon, 2012-07-09 16:44

Our article on this topic is the cover article in the July issue of Healthcare Financial Management and can be downloaded here.  This article provides an overview of capitation payment, the types of providers who can be capitated, and the relationships between the financial statements and incentives between providers and capitated organizations.  It also discusses metric

Risk Adjustment - Overfitting the Model

Submitted by jonpearce on Tue, 2012-06-26 13:02

Here's an interesting article that's essentially about trying too hard to develop a comprehensive model for healthcare risk adjustment.  It's from the Healthcare Economist blog entitled "Risk Adjustment: Overfitting the Model".  It describes a situation in which parameters are introduced to a model in an attempt to qualtify the effect of a factor, but that end up being more sensitive to the characteristics of an individual person (because of small sample size) than the factor itself.  Here's the link: