Risk Adjustment: How is the expected rate calculated? 

Question:  How is the expected rate calculated? Where does that number come from?

The expected rate is what we would expect that clinic or medical group's rate to be given the mix of patients being seen if the clinic or medical group were providing average quality of care. The rate is adjusting for differences in risk among specific patient groups by looking at factors such as patient age, diabetes type or insurance type (as a rough proxy for socioeconomic status). These factors will impact patients health outcomes and their ability to obtain recommended care, even if they clinic or medical group is providing the best possible care. For example, despite a clinic or medical group doing everything in its power to get a low-income patient screened for colorectal cancer, research shows the clinic or medical group will have a lower rate of success due to other barriers in that patient's life (e.g. transportation challenges, inflexible work hours, lack of childcare). This does not change the care that the clinic or medical group should provide to patients; it is designed to isolate the clinic or medical group's true impact on the health of their patients - thus allowing clinics and medical groups to be more easily compared. This process is called risk adjustment.

For more information, please visit our consumer website: http://www.mnhealthscores.org/frequently-asked-questions-0

Creation date: 5/20/2019 3:36 PM      Updated: 11/5/2019 1:14 PM
This category is for questions related to MNCM clinical measures.