Adjusting Risk Adjustment — Accounting for Variation in Diagnostic Intensity
In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicke...
| Main Authors: | , , , |
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| Format: | Article |
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New England Journal of Medicine
2018
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| Online Access: | http://hdl.handle.net/1721.1/114281 https://orcid.org/0000-0002-9941-6684 https://orcid.org/0000-0003-3910-1573 https://orcid.org/0000-0003-4364-1505 |
| Summary: | In the U.S. health care system, payments and performance measures are often adjusted to account for differences in patients’ baseline health and demographic characteristics. The idea behind such risk adjustments is to create a level playing field, so that providers aren’t penalized for serving sicker or harder-to-treat patients and insurers aren’t penalized for covering them. For example, the private insurance companies that participate in Medicare Advantage and the Affordable Care Act (ACA) exchanges receive risk-adjusted payments from the U.S. government, with the rationale that insurers should be reimbursed more for enrollees with higher expected costs. |
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