The role of risk adjustment in the assessment of medical practices in managed care.
As reliance on managed care to control the cost of health care in the United States grows, clinicians and managers will come under increasing competitive and regulatory pressure to identify and adopt the strategies and interventions that are not only most economical but that also best improve the health of the populations served. Explicit criteria will be embodied in public performance reports. Clearly, in comparing the performance of firms and of individuals who provide health care, disparities in risk among the patient populations will have to be compensated.
Department of Preventive Medicine and Biometrics, Uniformed Services University School of Medicine, Washington, DC.
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D000206:Actuarial Analysis; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D006801:Humans; D015273:Insurance Selection Bias; D008329:Managed Care Programs / Q000592:standards* / Q000706:statistics & numerical data; D015233:Models, Statistical; D009026:Mortality; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D012044:Regression Analysis; D018570:Risk Assessment; D012308:Risk Management / Q000706:statistics & numerical data*; D014481:United States