Which two data areas are combined to create member health risk profiles?

The correct answer is the combination of Provider Performance Assessment and Patient Outcome Monitoring to create member health risk profiles.

Provider Performance Assessment involves evaluating the effectiveness and quality of care provided by healthcare professionals. This data provides insight into the services rendered to patients, helping to understand how well those services align with best practices and patient needs.

Patient Outcome Monitoring focuses on the results of the healthcare provided to patients, reflecting how various treatments and interventions impact their health status over time. This information is vital in assessing the overall effectiveness of care and identifying areas for improvement.

By combining these two areas, healthcare organizations can better evaluate the risks associated with their patient population and tailor interventions to improve outcomes. This approach also facilitates more accurate risk adjustment in coding practices, impacting reimbursements and resource allocation.

Together, these data elements create a comprehensive health risk profile that helps identify at-risk members and guides decision-making for preventive care and chronic disease management, ultimately leading to enhanced patient care and resource utilization.