California has
launched a new effort to expand the use of managed care
within Medi-Cal. Under the "two-plan" model, enrollees
in 11 counties must choose either a private commercial
plan or one organized and operated by the county. The
implementation of this model has raised several questions
about the fit between Medi-Cal and private managed care.
This study analyzes and compares the resources used by
Medi-Cal enrollees and a sample of privately insured
employees. It also investigates Medi-Cal resource use
by county, thereby allowing for regional comparisons.
It finds that the two-plan model is practical, but that
risk-adjusted rates for short-term and high-risk Medi-Cal
clients may improve its long-term success. Click
for full report.
Canada examined
the performance of the ACG system in measuring the morbidity
of individuals and populations in the province of Manitoba.
This report reviewed many types of validity checks which
should be performed in jurisdictions considering using
the Johns Hopkins ACG system. This case-mix system holds
much promise for researchers and administrators interested
in using administrative data for describing case mix
and morbidity levels across individuals, physicians'
practices, and populations. Click
for full report.
The Center
for Health Program Development and Management at
the University of Maryland, Baltimore County, has been
working with the State
of Maryland since 1997 to make risk-adjusted
payments for its Medicaid program. The Center has integrated
the ACG Case-Mix System with the State of Maryland's
Information Systems to design risk-adjusted payment
methodologies. We have transitioned from assigning
payments based on historical fee-for-service data to
using MCO encounter data.
Minnesota: The Minnesota Department of Health provides information on the progress of risk adjustment in public programs. The Minnesota ACG Users Group is a voluntary association of individuals and organizations that are interested in understanding the issues surrounding risk adjustment. The Reporting Framework is designed to be helpful in describing the methodological decisions made in preparing an ACG-based report and to serve as a communication tool to allow users and recipients to appropriately interpret the results of analyses.
Oregon (link
not available)
Washington (link
not available)
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