5: Making Comparisons As senior epidemiologist in charge of leading a team in ev

Question

5: Making Comparisons As senior epidemiologist in charge of leading a team in evaluating different healthcare facilities around your county, you notice a report that your intern has submitted comparing the two different home health agencies in the area. Comfort Homes is the superior home health agency in the county and is much better than Adults Care. It has a hospitalization rate of 20% as compared to 30% at Adults Care. Based on this data, the facilities must be in better shape and the staff is more educated. As a result we need to encourage patients to use Comfort Homes until Adults Care can undergo a new training program." You immediately realize that this is an incorrect analysis and decide you need to educate your intern about risk adjustment. In your explanation to your intern please include: . What risk adjustment is Why risk adjustment is important, especially when comparing health care agencies Use several examples of how this report might be incorrect (must be specific to this situation)

Explanation / Answer

z1 - Risk adjustment is a process where it statistically considers the account of the latent health status and health spendings of the enrolled members who pay a premium on a regular basis for an Insurance plan when they are looking at their healthcare costs and results. It is basically a reverse mechanism.

2 - Risk Adjustment supports the cause of fair and reasonable premiums to the health insurance plans by pronouncing the efficiency and promoting high standards in healthcare, here are few more reasons to believe why risk adjustment is important.

3 - In the above-said example the intern has studied the report and compared the two healthcare providers, where he said that the rate of hospitalization at comfort homes is 20% as compared to Adult care which has hospitalisation rate of 30 %, here the health care at comfort homes shows 10% less, but the number of patients is not provided, there is a chance that the 20% has much lesser number of patients, or they might only take healty patients in their service, whereas the Adult care must have taken all patients in consideration irrespective of health condition, this may be one of the reason there is spike in number.

Secondly it the percentage signifies the risk adjustment, then the lower the number lower payout company has given to the patient, basically they have taken only more of the healthy patient so that the sick patients are less and the money is being transferred to the sick patient and making huge profits. But at the same time, the Adultcare is having a better payout than the Comfort homes as they may not discriminate between the sick and healthy patient and the payout rate is good. Hence the report by intern might be incorrect

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