Chapter 10 - Risk Adjustment

Question 1

Common risk adjustment factors can be classified into 5 categories:

Answer 1

1. Demographic (age,gender,race)
2. Clinical (co-morbidities)
3. Health related behaviours and activities
4. Socio-economic
5. Attitudes and perceptions

Question 2

Risk adjustment is useful for: (6)

Answer 2

1. Budgeting
2. Measuring efficiency (useful for price negotiations, network selection or insurance plans and managing facilities)
3. Risk Management (if budgets are exceeded, important to understand whether it is due to supply or demand)
4. Measuring healthcare outcomes (eg. Readmission rates)
5. Provider profiling (sharing info between doctors on a risk-adjusted basis increases awareness of the economic impact of clinical decisions)
6. Reporting on costs, outcomes and future plans

Question 3

Define:
1. Risk adjustment
2. Risk prediction
3. Case mix adjustment

Answer 3

1. Risk adjustment normalizes populations according to specified risk factors. It is applied to historical data
2. Risk prediction is used to predict future costs with reference to differences observed in the past
3. Case mix adjustment is a special case of risk adjustment uaed to compare treatment costs