Performance Improvement 2001. Comorbidity-Based Payment Methodology for Medicaid Enrollees with HIV/AIDS


The purpose of this study was to compare specific methodologies for setting capitation rates for people with HIV or AIDS and to analyze the predictive power of those payment models using data from the Medicaid program in Maryland. Specifically, the models tested were the current Maryland approach based on Ambulatory Care Groups, a payment model based on uniform payments for HIV-positive non-AIDS individuals, and a third model based incorporating information on co-morbidities. The three models were then evaluated by simulating payments under the three approaches and comparing them to actual costs of care under a range of different assumptions about the distribution of types of patients. The researchers conclude that the co-morbidity-based payment approach would more equitably reimburse managed care organizations for the costs of care for higher cost patients than the other two alternatives.


FEDERAL CONTACT: Richard Conviser, 301-443-3075

PIC ID: 7095

PERFORMER: Univ. of Maryland, Ctr. for Health Prog. Dev. Management, Baltimore, MD