Capping Individual Costs. The annual costs of individuals included in the savings calculation will be capped at the 99th percentile of annual expenditures. Medicare and Medicaid expenditures will be capped separately.
Capping Individual Costs. The annual costs of individuals included in the savings calculation will be capped at the 99th percentile of annual expenditures. Medicare and Medicaid expenditures will be capped separately. Savings Calculation: Savings will be calculated one cell at a time, one year at a time, and one cohort at a time, as follows: S$X,P = MX,D * (TPBPMX,P – PBPMX,D,P), where: S$X,P = savings in dollars for a particular cell (X) for a particular cohort in a particular Demonstration Year for a particular program (Medicare or Medicaid) MX,D = months of eligibility for the beneficiaries in cell (X) in the demonstration group. Each cell in the comparison group will have the same weight as the corresponding cell in the demonstration group. TPBPMX,P = target per beneficiary per month cost in cell (X) for a particular program. PBPMX,D,P = actual per beneficiary per month cost of the beneficiaries in cell (X) in the demonstration group for a particular program. The PBPMX,D,P is equal to the Medicare A/B costs or the Medicaid costs (excluding the costs above the cap) incurred during the period of eligibility for all beneficiaries in cell (X) in the demonstration group, divided by the months of eligibility for all beneficiaries in cell (X) in the demonstration group. Whenever a beneficiary is eligible for part of a month (e.g., for a death that occurs in the middle of a month), then a fraction of the month will be used in determining the total number of months of eligibility. Aggregate savings across all cells will be the sum of the savings for all cells and for both programs: S$A = ∑∑ S$X. The target PBPM (TPBPMX,P) is a projection of the baseline PBPM of a cell (X) and the program (P) of the demonstration group based on the rate of increase of the corresponding cell of the comparison group: TPBPMX,P = PBPMX,D,P(BY) * (PBPMXC,P(DY) / PBPMXC,P(BY)), where: PBPMX,D,P(BY) = the demonstration group PBPM in the base years in cell (X) and program (P) PBPMX,C,P(BY) = the comparison group PBPM in the base years in cell (X) and program (P) PBPMX,C,P(DY) = the comparison group PBPM in the Demonstration Year in cell (X) and program (P) Percentage savings in aggregate across all cells and both Medicare and Medicaid is calculated as follows: S%Cohort = S$Cohort / (MCohort * TPBPMCohort) Total dollar savings will be the dollar savings from those beneficiaries in the calculation of the percentage savings plus the attributed savings to the cohort of beneficiaries who become eligible for this Demo...
