Improving the AAPCC (adjusted average per capita cost) with health-status measures from the MCBS (Medicare Current...

Using data from the 1991 Medicare Current Beneficiary Survey (MCBS), multiple regression-based models predicting 1992 Medicare costs are developed and compared. A comprehensive model incorporating demographic, diagnostic, perceived health, and disability variables is shown to be stable and to fit the data well over the full range of Medicare-covered annual per capita expenses and for a variety of beneficiary subgroups defined by their health and functional status. This model produces stable unbiased estimates of expenditures on validation samples. A variant of this model is being considered for use in setting Medicare capitation payments for the second phase of the social/health maintenance organization (S/HMO) demonstration.