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Slide Presentation from the AHRQ 2007 Annual Conference

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Claims vs. Clinical Reporting

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  • 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

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