Please note that this information is historical and is to be used for informational purposes only.  We have discontinued the use of the risk adjusted cost index (RACI) to determine eligibility for the BlueChoice Solutions High Performance Network until national standards are more clear and we assess our alternatives. 

Risk Adjusted Cost Index (RACI): Reflects differences in the allowed costs of physician/professional provider episodes of care after adjustment for case-mix, severity of illness, comorbidity of patients, physician/professional provider specialty, and geographic region.

It measures the extent to which episodes of care managed by a physician or professional provider are more or less costly than peers within the same specialty in the same geographic region in the same time period after adjustment of case-mix, severity of illness and comorbidity conditions of the patients. A RACI may not be available where there is insufficient data or one is not calculated for the working specialty.

It is the ratio of the total allowed cost of Qualified Episodes for which a physician/professional provider is Attributed Responsibility divided by the total Expected Cost for episodes in the same Medical Episode Grouper® (MEG), Severity, Comorbidity Group, Specialty and Geographic Region.

Qualified Episodes:

An episode of care is composed of one or more encounters or visits, procedures or inpatient admissions. It is built by linking sets of health care services provided to a patient over time to treat a specific disease or health status. It continues as long as there is relatively continuous contact with the health care system for the same basic diagnosis, disease or health status.

The cost of an episode includes all allowed charges for all services provided by all physicians/professional providers, ancillary providers and facilities related to that episode of care.

Qualified Episodes:

• are complete,
• do not have extremely low or extremely high costs compared to others of the same Medical Episode Grouper (MEG)/Severity/Comorbidity Group,
• are within the normal scope of practice for the specialty.