TABLE 2.

Geocoded Socioeconomic Information Within a Typical Risk-Adjustment Model

Effect on Annual Plan Payments	Percent Change	95% CI, %		P
Geocoded socioeconomic background via the ABSM as a continuous measure	+1.1	+1.1	+1.2	<.001
Age, y (0–1 as referent)
2–6	−69	−69	−68	<.001
7–12	−75	−75	−74	<.001
13–17	−68	−68	−67	<.001
18–19	−65	−66	−65	<.001
Sex (male as referent)
Female	−6	−7	−5	<.001
No. of chronic conditionsa (0 as referent)
1	+156	+153	+159	<.001
2	+366	+362	+376	<.001
3	+685	+669	+708	<.001
4	+1233	+1181	+1287	<.001
≥5	+3312	+3019	+3597	<.001
Health plan typeb (employer insured as referent)
Self-insured	+13	+12	+14	<.001
Basic benefit designc (HMO as referent)
Preferred provider organization	−6	−7	−5	<.001
Point of service	+8	+6	+11	<.001
Study year (2008 as referent)
2009	−1	−2	0	.009
2010	+4	+3	+5	<.001
2011	+7	+6	+8	<.001
2012	+6	+5	+8	<.001

HMO, health maintenance organization.

^aPer the Agency for Healthcare Research and Quality Chronic Condition Indicator for the International Classification of Diseases, Ninth Revision, Clinical Modification.⁴¹

^bEmployer sponsored is when the employer purchases health insurance from a health plan on behalf of employees, and the insurer takes the financial risk. Self-insured means that the employer designs and funds his or her own health plan for employees; the employer takes the financial risk and may pay health plan fees to administer the health plan (eg, process claims).

^cHealth maintenance organization and point of service benefit designs typically require enrollees to designate a primary care provider who directs care within a designated network for which there are no or limited patient out-of-pocket costs; out-of-pocket costs rise if patients seek out-of-network care. In health maintenance organizations, patients must involve their primary care providers in directing care to a greater extent than in point of service plans. In preferred provider organization plans, primary care providers are not required to direct care, and enrollees typically pay some out-of-pocket amounts for the care they seek.