Risk Adjustment for Cost Analyses: The Comparative Effectiveness of Two Systems

Wagner TH. Risk Adjustment for Cost Analyses: The Comparative Effectiveness of Two Systems. [Cyberseminar]. 2013 Jun 19.

VA has been a leader in big data with an electronic medical record dating back to the early 1990s. Analysts can access billions of records to shed light on ways that we can improve the value of care provided to Veterans. However, a major hurdle in using secondary data is clinical heterogeneity - populations differ in their health and comorbidities and this heterogeneity can lead to biased regression coefficients. Trying to control for underlying clinical differences is the motivation behind risk adjustment. Different risk adjustment systems have evolved over the past three decades and VA has relied on one (DxCG provided by Verisk) for the recent work. Our work compares the DxCG model to a model that has been developed by Centers for Medicare and Medicaid Services for its Medicare Advantage Plans. This talk reviewed ongoing work describing how these two models work in VA, with implications for non-VA providers in this era of improving high value care.