Risk adjustment standards

Risk adjusting aligns the analysis of population groups to a common standard and allows an accurate performance comparison. Risk adjusting data for each population group involves three concepts:

• Observed value—could be expressed by the number of visits or cases for members attributed to that network
• Budget value—the expected utilization of a population adjusted for gender, age cohort, enrollment status and 3M clinical risk groups (CRGs)
• CRGs use standard claims data to assign each patient to a single, mutually exclusive risk category, and risk groups are weighted appropriately
• Percent difference