Improving health-based payment for Medicaid beneficiaries: CDPS.

This article describes the Chronic Illness and Disability Payment System (CDPS), a diagnostic classification system that Medicaid programs can use to make health-based capitated payments for TANF and disabled Medicaid beneficiaries. The authors describe the diversity of diagnoses and different burdens of illness among disabled and AFDC Medicaid beneficiaries. Claims from seven States are analyzed, and payment weights are provided that States can use when adjusting HMO payments. The authors also compare the taxonomy and statistical performance of CDPS to other leading diagnostic classification systems and find that the new model performs better in a number of respects.

The Community Medical Alliance: an integrated system of care in Greater Boston for people with severe disability and AIDS.

The Community Medical Alliance in Boston has adapted principles of prepaid managed care to redesign service delivery for people with severe physical disability and with late-stage AIDS. Experience to date suggests that the flexibility of capitation can be used to substantially shift care from its usual hospital focus to clinicians in home and community settings, especially nurse practitioners, with a high degree of patient satisfaction and without apparent compromise in quality. Instead of limiting access, managed care can use prepayment to support early interventions, coordination, and the development of services specifically designed to meet the needs of the target population.

Diagnostic risk adjustment for Medicaid: the disability payment system.

This article describes a system of diagnostic categories that Medicaid programs can use for adjusting capitation payments to health plans that enroll people with disability. Medicaid claims from Colorado, Michigan, Missouri, New York, and Ohio are analyzed to demonstrate that the greater predictability of costs among people with disabilities makes risk adjustment more feasible than for a general population and more critical to creating health systems for people with disability. The application of our diagnostic categories to State claims data is described, including estimated effects on subsequent-year costs of various diagnoses. The challenges of implementing adjustment by diagnosis are explored.

Making risk adjustment work for everyone.

This article explores how to reward health plans that serve people with disabilities and residents of low-income areas. We analyze health care expenditure patterns for Medicaid-covered persons with disabilities in Ohio, Missouri, Minnesota, and Wisconsin, demonstrating that diagnostic classifications are predictably related to resource utilization, and that health care expenditures are much more predictable for persons with disabilities than for the nondisabled. The implications of this analysis for risk-adjusted payment systems are explored. We also consider methods of assuring that health plans will provide high-quality care to the residents of inner city neighborhoods.

Suprasellar choristoma.

A case of choristoma of the posterior lobe of the pituitary is presented. The clinical presentation suggested chromophobe pituitary adenoma and the true diagnosis was only established on histological esamination. Despite the patient's advanced age her-operative course was satisfactory, but the disturbances of endocrine and visual function remained virtually unchanged. Perusal of the literature shows that this is the twentieth case of suprasellar or neurohypophyseal choristoma so far published. It provides an opportunity to review the clinical presentation, radiology and treatment, as well as to discuss the histiogenesis and nature of this rare pituitary tumor.