What does PMPM stand for in the context of risk adjustment payments?

Prepare for the Hierarchical Conditional Category (HCC) Test. Use flashcards and multiple choice questions with hints and explanations. Get ready for success!

Multiple Choice

What does PMPM stand for in the context of risk adjustment payments?

Explanation:
PMPM stands for per-member per-month—the rate used to express payments on a monthly basis for each enrolled individual. In risk adjustment and capitation models, plans receive a fixed amount for every member each month to cover expected care costs. That monthly per-member payment is exactly a PMPM, making the capitation framing the most appropriate description. The other options describe different concepts (like a projected or actual monthly cost or a per-visit charge), which aren’t what PMPM denotes.

PMPM stands for per-member per-month—the rate used to express payments on a monthly basis for each enrolled individual. In risk adjustment and capitation models, plans receive a fixed amount for every member each month to cover expected care costs. That monthly per-member payment is exactly a PMPM, making the capitation framing the most appropriate description. The other options describe different concepts (like a projected or actual monthly cost or a per-visit charge), which aren’t what PMPM denotes.

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