reports

Risk adjustment for asthma: variations by methodology and implications for providers

Working paper: Informed Purchasing Series. Hamilton, NJ, USA: Center for Health Care Strategies.

Center for Health Programs Development and Management, University of Maryland, Baltimore County, Baltimore, MD, USA

In Brief

• Risk adjustment is a method of determining the expected value of medical care that takes into account the health status of individuals when determining capitation payments.
• Health-based payment systems are more prevalent in the public sector, which is likely to continue as a major payer for pediatric asthma. Provider reimbursement rates have greater potential for covering costs of services when a health based payment system is used.
• Risk adjustment incorporating health status is an incentive that should reduce financial risk and adverse selection by managed care organizations and encourage access to appropriate specialty, routine, and preventive care.
• The use of risk adjustment strategies, accurate patient identification, and implementation of asthma disease management programs would have a significant effect on reducing barriers to financing pediatric asthma.