A new report was recently released by CMS that measures the accuracy of the risk adjustment models that CMS utilizes for Medicare Advantage plans, the Physician Group Practice demonstration and others, and is expected to be used for Accountable Care Organizations (ACOs). This report provides some interesting insights into the effectiveness of risk adjusters.
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Several years ago I worked on projects for four different clients that involved evaluating a change in the payment methodology of a major payer. This change had a major impact on revenue, and required analysis of historical data to estimate its effects.
The Healthcare IT Guy's recent blog about the analytical systems that ACOs will require does an excellent job of framing the issue of the IT needs of ACOs and other similar organizations. We would like to highlight several points from this article.
First, these systems will require data integration capabilities of a type not typically seen in hospitals. Hospital systems typically integrate data though the HL7 stan