Physician Profiling Using Outpatient Pharmacy Data as a Source for Case Mix Measurement and Risk Adjustment

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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.

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