▪ Abstract Important questions about health care are often addressed by studying health care
utilization. Utilization data have several characteristics that make them a challenge to …

In every system of health care, capitation payments have become the accepted tool used by
health care purchasers in much of the developed world to determine prospective budgets …

This article describes the CMS hierarchical condition categories (HCC) model implemented
in 2004 to adjust Medicare capitation payments to private health care plans for the health …

This article describes a new case-mix methodology applicable primarily to the ambulatory
care sector. The Ambulatory Care Group (ACG) system provides a conceptually simple …

Because of workforce needs and demographic and chronic disease trends, nurse
practitioners (NPs) and physician assistants (PAs) are taking a larger role in the primary care …

ONE OF THE BEST KNOWN tradeoffs in insurance economics is between risk aversion and
moral hazard. Greater insurance coverage implies less risk bearing by the insured but …

Traditionally, linear regression has been the technique of choice for predicting medical risk.
This paper presents a new approach to modeling the second part of two-part models …

In the 1990s many countries have chosen to use prospective payment arrangements for
health plans (eg, health insurers, sickness funds or HMOs) together with health plan …

Objective To develop Clinical Risk Groups (CRGs), a claims-based classification system for
risk adjustment that assigns each individual to a single mutually exclusive risk group based …

Objectives. Develop and estimate the RxRisk model, a risk assessment instrument that uses
automated ambulatory pharmacy data to identify chronic conditions and predict future health …