Comparing accuracy of risk-adjustment methodologies used in economic profiling of physicians

Published: June 1, 2004
Category: Papers
Authors: Grazier KL, Thomas JW, Ward K
Country: United States
Language: null
Types: Care Management, Performance Analysis
Settings: Academic, Hospital

Inquiry 41:218-231.

Department of Health Management and Policy, School of Public Health, University of Michigan, USA

This paper examines the relative accuracy of risk-adjustment methodologies used to profile primary care physician practice efficiency. Claims and membership data from an independent practice association health maintenance organization (HMO) were processed through risk-adjustment software of six different profiling methodologies. The Group R2 statistic was used to measure, for simulated panels of HMO members, how closely each methodology’s cost predictions matched the panel’s actual costs. All but one methodology explained at least 50% of panel cost variance with panels as small as 25 patients. Group R2 performance tended to be better when high-cost cases were included rather than excluded from the analyses.

PMID: 15449435

Predictive Risk Modeling,Cost Burden Evaluation,Resource Use,United States,Costs and Cost Analysis,Efficiency,Organizational,Models,Theoretical,Software

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