2 Decades Of Research That Led To The Adoption Of Risk Adjustment Tools Recognized By Award

Main Category: Public Health
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 05 Feb 2008 - 5:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

The 2008 HSR Impact Award, presented at the AcademyHealth National Health Policy Conference in Washington, D.C., honored two decades or research that ultimately brought risk adjustment to many users, including Medicare.

Now in its third year, the AcademyHealth HSR Impact Award identifies outstanding examples of the positive impact of health services research on health policy or practice. Principal Investigator Dr. Arlene Ash and colleagues from DxCG accepted the award from presenter Lou Rossiter.

In the early 1980s, the Centers for Medicare and Medicaid Services (CMS, then called the Health Care Financing Administration) needed a practical method to calculate medical-risk-based payments for its new Medicare risk contracting (HMO) program. The urgency increased with studies suggesting that Medicare HMOs enrolled healthier-than-average members, while the sickest beneficiaries remained enrolled in Medicare's traditional fee-for-service program. The award-winning research, originally funded by Medicare, made significant contributions to the development of Diagnostic Cost Group (DCG) models, and, more broadly facilitated the adoption of risk adjustment tools in health care financing and administration. Risk-adjusted payments are designed to provide plans with the money needed to care for sick patients while not overpaying for healthy ones. It is now widely recognized that virtually all provider assessments require risk adjustment, because appropriate and expected costs, processes and outcomes of care vary greatly across providers' very different patient panels.

Through numerous peer-reviewed publications, national and international presentations, consulting and congressional testimony, the award recipients have promoted and facilitated risk adjusted payments for protecting sick people and their providers. The research also provided the technical and practical tools that have helped make risk adjustment integral to health care management and financing today.

----------------------------
Article adapted by Medical News Today from original press release.
----------------------------

About Health Services Research

Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations.

About AcademyHealth

AcademyHealth is the professional home for health services researchers, policy analysts, and practitioners, and a leading, non-partisan resource for the best in health research and policy. AcademyHealth promotes interaction across the health research and policy arenas by bringing together a broad spectrum of players to share their perspectives, learn from each other, and strengthen their working relationships. For more information, view our Web site at http://www.academyhealth.org/.

Source: Kristin Rosengren
AcademyHealth