For PSNs, PMPM
expenditures were the sum of all paid amounts for claims in a given month, including a monthly patient case management fee paid to PSN providers, whereas for HMOs, the PMPM
expenditures were simply the monthly risk-adjusted capitated premiums.
When examining unadjusted difference-indifferences results prior to matching, we did not find significant differences in costs and utilization between the two groups except that PMPM
costs increased slightly more in the intervention group, although it was not statistically significant at the 5 percent level (Table 3).
For each product and customer, premium revenues and medical care claims (direct) costs are expected to have a linear relationship with the annual average number of members, hence the linear GM PMPM
line in Figure 1.
In addition, a slight effect on incremental PMPM
costs will be observed, as the difference in number of surviving patients receiving rFVIIa compared with standard care would increase.
For HMOs, the PMPM
premium is regressed against total Medicare payment (Part A plus Part B), with similar controls included.
Results showed that the second method, truncating PMPM
charges at three standard deviations above the mean within ACGs, both maximized predictive performance of the corresponding ACG weights and minimized the exclusion of observed charges from the weight calculation.
Significantly, our highest risk population baseline PMPM
of $2,500 dropped by 37 percent to $1,587.
Serious consideration should be given to privatization, since managed care insurance can be purchased, even when risk adjusted for prior disability, for considerably less than the PMPM
figures calculated for VA delivered care.
The same selection criteria for enrollees and services used for the calculation of PMPM
expenditures in the reform counties were used to calculate PMPM
expenditures for enrollees in the nonreform counties.
SCAN Health Plan had case management costs of $12 PMPM
, while the other three plans showerd the same $7 PMPM
Inpatient utilization decreased approximately 4%, contributing to a decrease of approximately 5% in inpatient facility costs PMPM
to Medicare coverage costs depending on which conditions the drugs are approved to treat.