UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Adolescent; Adult; Aged; Aged, 80 and over; *Capitation Fee; Centers for Medicare and Medicaid Services (U.S.); Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; International Classification of Diseases; Male; Medicare Part C; Middle Aged; Models, Organizational; *Risk Adjustment; United States


Biostatistics | Epidemiology | Health Services Research


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 expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary payer subpopulations are discussed.


Health Care Financ Rev. 2004 Summer;25(4):119-41. Link to article on publisher's site

Journal/Book/Conference Title

Health care financing review

PubMed ID


Related Resources

Link to Article in PubMed



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