MN Community Measurement began a concerted effort in 2012 to evaluate when, where and how risk adjustment was appropriate for our publicly reported performance measures. After several years of effort and community input, we will launch data for five risk adjusted measures next month.
Risk adjustment is a technique used to level the playing field for clinics/medical groups by adjusting for the differences in risk amongst specific patient groups. The process should isolate the clinic/medical group’s true impact on patients’ health and allow them to be compared more easily.
In 2012, a Risk Adjustment Task Force was commissioned by MNCM’s Measurement and Reporting Committee (MARC) to make recommendations on how and when adjusted rates should be presented; what methods should be used for risk adjustment; and how risk adjustment should be balanced against data collection burden and other organizational priorities. The Task Force recommendations were presented to MARC and approved by the Board in mid-2013.
For the past 18 months, MNCM has convened a Risk Adjustment Workgroup charged with evaluating each measure to determine its appropriateness for risk adjustment and, if appropriate, what variables should be used to perform the risk adjustment.
MNCM is utilizing an Actual to Expected methodology. This methodology does not alter a clinic/medical group’s result; the actual rate remains unchanged. Instead, each clinic/medical group’s rate is compared to a unique expected rate for that clinic/medical group that is based on the mix of patient risk seen at that clinic/medical group, rather than the raw market average.
The initial launch of risk-adjusted data will include five Direct Data Submission (DDS) measures: Optimal Diabetes Care, Optimal Vascular Care, Optimal Asthma Care – Adults, Optimal Asthma Care – Children and Colorectal Cancer Screening. The adjusted rates will be displayed on MNHealthScores.org and in the MNCM Data Portal beginning in March.
Subsequently, the Risk Adjust Workgroup will reconvene to begin the process of studying other MNCM measures to determine their fitness for risk adjustment in the future. The first under consideration will be our suite of depression care measures.
More details about our risk adjustment methodology and the variables used for the measures noted above can be found on pages 170-171 of the 2014 Health Care Quality Report. Adjusted and unadjusted rates for the measures noted above are also available in the appendix of that report.