Physician profiling using outpatient pharmacy data as a source for case mix measurement and risk adjustment.
Pharmacy data are a potential source of information on the health risks of members in a managed care organization (MCO). Reasons why these data can serve as a basis for case mix measurement of MCO populations are reviewed. Several pharmacy-based case mix measurement systems (CDS, KPARx) are summarized. Applications of pharmacy-based case mix systems for profiling of primary physician panels in an MCO are discussed and illustrated with several examples.
Roblin
D W
DW
Care Management Institute, Kaiser Permanente, Oakland, CA, USA.
D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008329:Managed Care Programs / Q000191:economics; D020380:Needs Assessment; D010593:Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000145:classification; D011320:Primary Health Care / Q000191:economics; D020379:Risk Adjustment / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D014481:United States