Risk Scores and provider size

At a recent AcademyHealth presentation, Cheryl Damberg discussed her research to design a P4P program for implementation for Integrated Healthcare Association (IHA).  One thing I noticed about the presentation was that smaller provider groups had patients with lower risk scores (i.e., healthier patients).  Is it really the case that small providers treat much healthier patients?…

Problems with Risk Adjustment

To evaluate providers based on the health outcomes or the cost of care, one must attempt to evaluate dimensions of care which are strictly within the providers control. For instance, if a physicians treats two patients with breast cancer, but one patient has a more advanced form of breast cancer, one should take this difference…

Risk Adjustment: Predicting Future Expenditures

Many states rely on managed care organizations (MCOs) to provide medical services for their Medicaid beneficiaries.  Contracting out medical services to private providers relies on the government’s capacity to accurately predict expected cost of care for each beneficiary.  This is typically done through risk-adjusted capitation rates. Which risk adjustment strategy works best?  The answer of…

Risk Adjustment Models

Risk adjustment is important for many aspects of health care.  Medicare uses risk adjustment to modify payments to Medicare Advantage (Part C) plans based on the health of the beneficiaries they cover.  Private insurance companies can use risk adjustment to fine-tune capitation payments to physicians or determine a potential enrollee’s premium.  Providers can use risk…