Insufficient risk adjustment is a dangerous consequence of incorrectly implemented value-based care models, explained Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.
Insufficient risk adjustment is a dangerous consequence of incorrectly implemented value-based care models, explained Justin Bachmann, MD, MPH, FACC, instructor of Medicine and Health Policy at Vanderbilt University Medical Center.
Transcript
How are value-based care models done incorrectly and what can be the consequences of those flaws?
I think the probably one of the real dangers of measuring value, I guess, inelegantly or perhaps incorrectly is just insufficient risk adjustment. Risk adjustment is never going to be perfect and at the end of the day we have to try to measure value. But if the risk adjustment is wildly imperfect then that can lead to patient selection and also sometimes provider selection.
For example, we know from prior episodes in New York and Pennsylvania in the early '90s, when mortality rates were reported on that were not sufficiently risk adjusted that led to a lot of patient selection. Patients—and this was demonstrated by an economist—who were sicker, providers were selecting patients who were healthier for procedures. Those were the types of change in behavior that you’ll see if there is insufficient risk adjustment.
I think the other thing that really has to be thought about and that people need to be cognizant of is the role of statistical variation in measuring value. Justin Dimick, MD, MPH, a health services researcher, posted a paper in 2006 in JAMA where he demonstrated that on average for a hospital center to be able to detect an increase of the mortality rate twice that of the national benchmark then that facility had to be doing about 270 bypasses and that’s over the course of 1 year. So that’s to detect an increase over the statistical margin of error. You start breaking that down at the provider level and pretty quickly you get within your error bars.
A lot of times when we talk about value-based care we talk about benchmarking, comparing providers to other providers, comparing facilities to other facilities, and there really almost always needs to be some other sort of error bar, some sort of measure so that people are actually cognizant of what is just random variation and what isn’t. If it’s within the error bar, it’s just random variation and one can’t be confidant of those results and they can lead to really, sometimes, dangerous conclusions.
Award-Winning Poster Presentations From AMCP 2024
April 23rd 2024At the Academy of Managed Care Pharmacy (AMCP) 2024 annual meeting, multiple poster presentations concerned with health equity, data collection, glucagon-like peptide-1 agonists, and more were acknowledged for their originality, relevance, clarity, bias, and quality.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Standard Criteria for Loss of Ambulation Needed in DMD
April 19th 2024A recent study suggests the differences between ambulation definitions for patients with Duchenne muscular dystrophy (DMD) can impact the identification of ambulant vs nonambulant individuals, and standard criteria across settings are needed.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More