Gain-sharing arrangements typically attempt to align physicians' and hospitals' financial incentives when rendering inpatient care to patients. Concern exists that these arrangements, which include clinical joint ventures such as the joint ownership of specialty hospitals, could be abused. Some believe these enterprises may adversely affect the quality of care and be manipulated to compensate physicians for referrals. Formerly referred to as the Health of Seniors survey, the HOS gathers self-reported information about health status, functional capacity, and concerns about efficacy of health care. The HOS is used to assess changes in the health status of Medicare beneficiaries enrolled in MCOs.
Information is collected biennially.
Health Plan Management System. To estimate future health care costs, this risk adjustment method uses clinical information such as ICD-9 diagnoses from inpatient and outpatient care sites. The federal government plans to start using HCCs to adjust Medicare capitation rates for member health status in 2004. Market share capitation. This payment method bases the annual amount physician specialists receive for a defined bundle of services on the percentage of the MCO's members who use the specialty during the year.