Definitions for "Risk adjustment"
The adjustment of premiums to compensate health plans for the risks associated with individuals who are more likely to require costly treatment. Risk adjustment takes into account the health status and risk profile of patients.
The statistical adjustment of outcomes measures to account for risk factors that are independent of the quality of care provided and beyond the control of the plan or provider, such as the patient's gender and age, the seriousness of the patient's illness, and any other illnesses the patient might have. Also known as case-mix adjustment. (2)
Comparing hospitals on their outcomes is difficult because different hospitals treat different types of patients. Some hospitals treat patients who are older or sicker than those at other hospitals. A technique called risk-adjustment accounts for these differences in patient characteristics. Risk factors are the patient demographic (e.g. age, gender) and clinical (e.g. diabetes, hypertension) characteristics that might influence the outcome of medical care.