R. Adams Dudley, M.D., M.B.A

R. Adams Dudley, M.D., M.B.A. is Associate Professor of Medicine and Health Policy at the University of California, San Francisco (UCSF). His research primarily focuses on purchaser behavior and the failure of the health care market to reward quality and compensate those who assume a disproportionate share of sicker patients. Dr. Dudley focuses on improving the measures of quality of care, the techniques for health plan and provider risk-adjustment, and the feasibility of shifting market participant focus from price to quality.

Dr. Dudley received his M.D. from the Duke University in 1991 and his M.B.A. from Stanford in 1990. He completed his pulmonary and critical care fellowship at UCSF after an internal medicine residency at the Massachusetts General Hospital. Dr. Dudley went on to become a Pew Charitable Trusts Fellow in Health Policy at UCSF, then joined the faculties of the Pulmonary Division and the Institute for Health Policy Studies at UCSF in 1997. His major academic activities include several health services research and health policy projects, various advisory committees, and teaching in the Pulmonary Clinic and the intensive care unit.

Dr. Dudley's HCFO-funded work informed policymakers about different risk-adjustment strategies in varying selection situations. Dr. Dudley and his research team recognized that a major limitation of existing diagnosis-based risk adjustment approaches was that they created concern among clinicians and policymakers about the potential for gaming (that is, reporting a patient's health status to be worse than it actually was). They found, however, that they could develop risk adjustment methods that focused on diagnoses that were clinically verifiable. They considered a condition verifiable if its diagnosis rested on clinical evidence that would, in an audit, include unequivocal evidence that the condition was present (for example, no one makes the diagnosis of lung cancer without a biopsy specimen showing cancer, and no one makes the diagnosis of HIV without a reproducible laboratory test showing the virus is present). Finding the patients with just the 100 most expensive verifiable conditions accounted for almost 50 percent of total health system costs and more than 80 percent of the variation in cost among patients (as measured by R2). This approach of focusing on a short list of verifiable conditions was adopted by CMS for the Medicare Advantage plan premium payments, rather than the previously-proposed approach that involved accounting for all diagnoses in any patient.

In addition to his academic work, Dr. Dudley participates in community service activities including consulting on health policy issues with the Institute of Medicine (the National Roundtable on Quality of Care, the Committee on Quality of Health Care in America, and the National Cancer Policy Board), the Pacific Business Group on Health, General Motors, the Leapfrog Group, other large employers, as well as maintaining an active membership with AcademyHealth, the American Thoracic Society, and other medical societies.

For more information on R. Adams Dudley, M.D., M.B.A., and a list of select publications, please visit his faculty webpage, at pulmonary.ucsf.edu/faculty/dudley.html

Publications from HCFO-sponsored work:

Luft, H. and Dudley, R. "Assessing risk adjustment approaches under non-random selection," Inquiry, 41., 2., September 2004, pp. 203-17.