Skip to content

Risk Adjustment and Capitation Calculator MicroSim

Run the Risk Adjustment and Capitation Calculator MicroSim MicroSim Fullscreen

About This MicroSim

This calculator shows how risk adjustment and capitation work together to determine a provider group's finances. The HCC risk score rises with patient age and chronic-condition prevalence; multiplying it by the base per-member-per-month (PMPM) rate gives the risk-adjusted payment, and times the panel size and twelve months gives annual capitation revenue. Projected medical costs also scale with risk, so a sicker panel earns more but costs more — and the operating margin can easily go negative without effective care management.

How to Use

Adjust the panel size, average age, and chronic-condition prevalence sliders to change the risk profile (watch the risk distribution and mean shift), and set the base PMPM rate. The financial panel shows risk-adjusted revenue, projected cost, surplus or deficit, and operating margin. When the margin runs thin, raise the care-management slider to reduce high-risk utilization and push the panel back toward the black — the central financial challenge of managing care under capitation.

Iframe Embed Code

You can add this MicroSim to any web page by adding this to your HTML:

1
2
3
4
<iframe src="https://dmccreary.github.io/modeling-healthcare-data/sims/risk-adjustment-capitation-calculator-microsim/main.html"
        height="450px"
        width="100%"
        scrolling="no"></iframe>

Lesson Plan

Grade Level

9-12 (High School Geometry)

Duration

10-15 minutes

Prerequisites

TODO: List prerequisites.

Activities

  1. Exploration (5 min): TODO
  2. Guided Practice (5 min): TODO
  3. Assessment (5 min): TODO

Assessment

TODO: List assessment criteria.

References

  1. TODO: Add references.