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Risk Scoring and the Luck of the Draw

Submitted by jonpearce on Sun, 2011-03-20 17:13

Many recent healthcare initiatives, including the Accountable Care Organizations that are created under health reform, utilize risk adjusters to compensate for the differences in disease status of the members.  These risk adjusters are used to establish payment targets that compare costs incurred by patients in the organization to what the costs “should be” based on those patients’ diagnoses.  The accuracy of the risk adjusters, therefore, is critically important when significant amounts of money are involved.  A small percentage difference between the risk-