When evaluating the success of providers in meeting standards, a health plan must make adjustments for case mix or severity. One true statement about case mix/severity adjustments is that they:
A) Typically are more important in measuring the performance of PCPs than they are in measuring the performance of specialists
B) Help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient
C) Tend to increase the number of providers who are considered to be outliers
D) Allow for a more equitable comparison of data between providers of outpatient care but not providers of inpatient care

Question

Quizplus · Accepted Answer

Case mix/severity adjustments help compensate for any unusual factors that may exist in a provider's patient population or in a particular patient, which makes the evaluation of the success of providers in meeting standards more accurate and fair. They are important for both PCPs and specialists and can increase the number of providers who are considered outliers. These adjustments can be applied to both outpatient and inpatient care.

When Evaluating the Success of Providers in Meeting Standards, a Health