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Outpatient Encounter Data for Risk Adjustment

2002· article· en· W2313622815 on OpenAlexaff
W. Pete Welch

Bibliographic record

VenueJournal of Ambulatory Care Management · 2002
Typearticle
Languageen
FieldHealth Professions
TopicElectronic Health Records Systems
Canadian institutionsVictoria Park
Fundersnot available
KeywordsPaymentIncentiveAuditMedical diagnosisBusinessHealth careActuarial scienceQuality (philosophy)Data qualityService (business)Medical emergencyMedicineFinanceMarketingEconomicsAccounting

Abstract

fetched live from OpenAlex

Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-service (FFS) data face several threats to their validity, including the possibility that they may seriously underreport diagnoses. Because the systems and incentives that yield FFS and managed care diagnosis data are quite different, they may not be comparable, depending on circumstances such as audit rules. The next generation of risk adjustment models should be designed around the capabilities and potentialities of plans' information systems.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.019
metaresearch head score (Gemma)0.205
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: none
GenreCandidate signal: Other · Consensus signal: none
Teacher disagreement score0.019
Threshold uncertainty score0.103

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0190.205
Meta-epidemiology (narrow)0.0010.001
Meta-epidemiology (broad)0.0020.002
Bibliometrics0.0060.011
Science and technology studies0.0010.000
Scholarly communication0.0030.003
Open science0.0020.002
Research integrity0.0010.003
Insufficient payload (model declined to judge)0.0170.006

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.086
GPT teacher head0.408
Teacher spread0.322 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designNot applicable
Domainnot available
GenreOther

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations5
Published2002
Admission routes1
Has abstractyes

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