Adjusting Population Risk for Functional Health Status

Population Health Management
Richard L FullerNorbert I Goldfield

Abstract

Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R(2) statistic, by 5% across all Medicare en...Continue Reading

References

Sep 8, 2012·Medical Care Research and Review : MCRR·Richard L FullerJames C Vertrees

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Citations

Jan 5, 2020·PM & R : the Journal of Injury, Function, and Rehabilitation·Sean D RundellJeffrey G Jarvik
Jun 6, 2020·Journal of Aging and Health·Chih-Ying LiKenneth J Ottenbacher
Aug 15, 2019·Systematic Reviews·Jia Loon ChongDavid Bruce Matchar
Apr 2, 2020·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Laisa Socorro Briongos-FigueroJuan Carlos Martín-Escudero
Jun 30, 2019·Journal of Pain and Symptom Management·Donald H TaylorJanet Bull
Sep 3, 2021·Journal of the American Medical Directors Association·Chih-Ying LiKenneth J Ottenbacher

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