Case mix, risk adjustment, reinsurance, and health reform

Case mix measures represent the fundamental tool that measures clinical differences in groups of patients. It is important to be careful how these measures are used, as quality of care delivered to patients is at stake. Risk adjustment methodologies are excellent for physician profiling if one adopts them as the first step in the quality improvement process. Differences in hospital or primary care practice profiles, adjusted for the case mix measures, often reveal quality improvement opportunities. This first step is the easy part. The hard part comes in working together with the health care team to determine the sources for these differences. After identifying and implementing solutions, the quality improvement process just continues. As benefits true commitment to quality improvement, risk assessment methodologies will only improve. In turn, this will provide the health care team with a greater ability to deal with "treasures" uncovered by applying case mix measures.