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Physician profiling using outpatient pharmacy data as a source for case mix measurement and risk adjustment
1Care Management Institute, Kaiser Permanente, Oakland, CA, USA.
The Journal of Ambulatory Care Management
|July 1, 1999
Abstract:
Pharmacy data are a potential source of information on the health risks of members in a managed care organization (MCO). Reasons why these data can serve as a basis for case mix measurement of MCO populations are reviewed. Several pharmacy-based case mix measurement systems (CDS, KPARx) are summarized. Applications of pharmacy-based case mix systems for profiling of primary physician panels in an MCO are discussed and illustrated with several examples.