David Knutson is Director of Health Systems Studies at the Health Research Center of the Park Nicollet Institute in Minneapolis. The Health Research Center conducts clinical and health services research. Prior to coming to the Park Nicollet Institute, he was directed of provider contracting for MedCenters Health Plan and later for Aetna Health Plans. He has directed EMS and long-term care health planning for a regional planning commission and directed a hospital and community-based mental health program. Mr. Knutson conducts research related to risk adjustment; purchasing methods; the use of quality information by purchasers, health plans, and consumers; and on the organizational and economic issues associated with chronic illness management.

Recently, he completed a project, funded by HCFO that evaluated the implementation and impact of purchaser use of health-based risk adjustment to pay health plans. He concluded that purchasers by and large find formal health-based risk adjustment meets their expectations and is feasible to implement. Health plans subject to risk-adjusted payments also are supportive. Surveys of health plans and the population of health actuaries in the United States showed that health-based risk adjustment significantly reduced concerns about a negative financial impact resulting from attracting a disproportionate share of high-risk enrollees. The project Web site, www.riskadjustment.org, provides implementation information about each purchaser and a summary of lessons learned, as well as an updated bibliography.

Mr. Knutson currently serves as co-principal investigator for a project, supported by the Agency for Healthcare Research and Quality (AHRQ), on purchaser and plan use of provider and consumer incentives to accelerate quality improvement in Minnesota and Colorado. He also is studying organizational and economic issues related to implementing a chronic care program for individuals with diabetes in 11 provider systems in the United States. Previously, Mr. Knutson led work, under a Center for Medicare & Medicaid Services (CMS) contract, to forecast the potential impact of incentives on changes in diagnosis and coding patterns when the new Medicare +Choice risk adjustment method is implemented in 2004. He also served as co-principal investigator on an evaluation of the comparative predictive performance of prominent risk adjustment models for the Society of Actuaries.

Mr. Knutson notes, “HCFO's strategic focus and combination of supporting research, publishing policy analyses, and convening timely meetings of experts and stakeholders has been a major driver in the development and diffusion of health based risk adjustment methods from research to application, including producing breakthroughs among stakeholders when diffusion stalled.” Risk assessment tools and/or risk-adjusted payments are being implemented for multiple purposes in the United States and around the world.

Mr. Knutson has a BA in biology and psychology and is currently pursuing a graduate degree program in health economics.

Selected References

Gifford G, Edwards K, Knutson D. “Health-based Capitation Risk Adjustment in Minnesota Public Health Care Programs. Forthcoming in Health Care Financing Review.

Knutson D. “In-depth look at the Buyers Health Care Action Group (BHCAG) of Minnesota’s Choice Plus Program,” in Financial Strategy for Managed Care Organizations: Rate Setting, Risk Adjustment, and Competitive Advantage by Charles William Wrightson, Jr. (Chicago: Health Administration Press, July 2002)

Cumming RB, Knutson D, Cameron B, Derrick B. A Comparative Analysis of Claims-based Methods of Health Risk Assessment for Commercial Populations. A research study sponsored by the Society of Actuaries. May 2002.

Knutson D, Fowles J, Kind E. Implementing Health-based Risk Adjustment for Payment of Managed Care Organizations: Issues and Methods. Commissioned paper by the American Association of Health Plans. January 2000.

Knutson D. “Implementing health-based payment: Case study of the Minneapolis Buyers Health Care Action Group.” Inquiry, Summer, 1998, Vol. 35, No. 2.

Knutson D, Kind E, Fowles J. “The impact of report cards on employees: A natural experiment.” Health Care Financing Review, Fall, 1998, Vol. 20, No. 1.

Knutson D, Fowles J. “Implementing Health-based Risk Adjustment: Lessons from the Field.” RAIS: The Risk Adjustment Impact Study, Health Research Center, Park Nicollet Institute, 2001-2003. Copyright ©, Park Nicollet Institute, 2001.