What is risk adjustment - Answers Using statistical methods to account for population
differences unrelated to the outcome.
Benefits of risk adjustment - Answers Makes comparisons fair, improves cost prediction,
prevents unfair penalties for high-risk groups.
Direct adjustment - Answers Applying rates from a small population to a large reference
population.
Indirect adjustment - Answers Applying rates from a large reference population to a smaller
population.
Concurrent (retrospective) risk adjustment - Answers Using current-year data to predict
expenditures or future outcomes.
First step of developing a risk prediction model - Answers Define the population.
Predictor variables in a risk model - Answers Predisposing, enabling, and reinforcing factors.
Outcome variable in a risk prediction model - Answers The health result you are trying to predict
or prevent.
Definition of a determinant - Answers A factor that influences a health outcome.
Definition of an outcome - Answers A measurable health result such as incidence,
hospitalizations, or deaths.
Common data sources for population assessment - Answers Medical claims, pharmacy claims,
surveys, hospital data, social media, County Health Rankings.
Steps of a population assessment - Answers Define determinants/outcomes → define
population → explore data → add context → identify opportunities → prioritize populations.
Population segmentation - Answers Dividing the population into meaningful groups (geographic,
demographic, behavioral, attitudinal).
Risk stratification - Answers Sorting individuals into tiers based on their level of health risk.
Macro-level intervention - Answers A system-level or policy-level intervention.
Meso-level intervention - Answers A clinic-level or provider-level intervention.
Micro-level intervention - Answers An individual patient-level intervention.
Monitoring - Answers Checking program fidelity—whether the intervention is delivered as
intended.