Open Access. Powered by Scholars. Published by Universities.®
- Discipline
Articles 1 - 2 of 2
Full-Text Articles in Medicine and Health Sciences
Profitably Risky: A Study Of Medicare Capitation Contracts For Primary Care Medical Practices, Michael Wieck
Profitably Risky: A Study Of Medicare Capitation Contracts For Primary Care Medical Practices, Michael Wieck
Dissertations
The Centers for Medicare and Medicaid Services is seeking to move medical providers from a fee-for-service reimbursement model to a value-based reimbursement model. In this dissertation, we studied the financial rewards and risks that accompany capitation contracts. We employed Poisson regression to estimate health-care utilization of beneficiaries under the care of primary care providers with varying levels of capitation. Then, we calculated capitation contract results for primary care practices using Monte Carlo simulations. We used three methods to predict medical payments for beneficiaries: (1) empirical probability distributions of annual medical payments, (2) theoretical probability distributions of annual medical payments, and …
The Impact Of Medicare Insurance Plans Upon Healthcare Services Utilization Considering Patients' Characteristics And Their Access To Medical Care, Steven Stout
Dissertations
The annual average cost of healthcare for services utilization by a Medicare beneficiary is projected to grow from about $10,000 to over $16,000 by 2023. As an ongoing initiative to address this trend, the federal government contracts with private insurance companies and other entities, called Medicare Advantage Organizations (MAOs), to develop and administer alternative health insurance plans designed to contain service utilization and costs. One feature of some Medicare Advantage plans is the presence of risk-bearing contracts with primary care physician organizations that voluntarily accept financial responsibility for the overall cost of care for patients attributed to them. In this …