Slide Presentation from the AHRQ 2007 Annual Conference

Claims vs. Clinical Reporting

• Uninsured not captured
• Services delivered, not health outcomes
• Non-reimbursable services not captured
• Inaccuracy due to income maximization
• Difficult to risk adjust (severity, stage)
• Lack of continuity with one health plan
• Fragmented health care market (and claims)
• Provider resistance