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. 2000 Spring;21(3):7-28.

Using diagnoses to describe populations and predict costs

A S Ash  1 , R P Ellis, G C Pope, J Z Ayanian, D W Bates, H Burstin, L I Iezzoni, E MacKay, W Yu
Affiliations

Using diagnoses to describe populations and predict costs

A S Ash et al. Health Care Financ Rev. 2000 Spring.

Abstract

The Diagnostic Cost Group Hierarchical Condition Category (DCG/HCC) payment models summarize the health care problems and predict the future health care costs of populations. These models use the diagnoses generated during patient encounters with the medical delivery system to infer which medical problems are present. Patient demographics and diagnostic profiles are, in turn, used to predict costs. We describe the logic, structure, coefficients and performance of DCG/HCC models, as developed and validated on three important data bases (privately insured, Medicaid, and Medicare) with more than 1 million people each.

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Figures

Figure 1
Figure 1. Sample of a Condition Category Hierarchy: Gastrointestinal (GI) Disorders
Figure 2
Figure 2. Sample Information Used to Predict Next Year's Expenses for Privately Insured Patients
Figure 3
Figure 3. Predictive Ratios for the Private Validation Sample, by Presence of Medical Condition
Figure 4
Figure 4. Means of Actual and Predicted Costs for the Private Validation Sample, by DCG-Prediction Group
See this image and copyright information in PMC

References

    1. Ash A, Porell F, Gruenberg L, et al. An Analysis of Alternative AAPCC Models Using Data from the Continuous Medicare History Sample. Final Report to the Health Care Financing Administration; Health Policy Research Consortium; Boston: Brandeis/Boston Universities; Sep, 1986.
    1. Ash A, Porell F, Gruenberg L, et al. Adjusting Medicare Capitation Payments Using Prior Hospitalization. Health Care Financing Review. 1989;10(4):17–29. - PMC - PubMed
    1. Ash A, Ellis RP, Yu W, et al. Final Report to the Health Care Financing Administration under Contract Number 18-C-90462/1-02. Boston University; Boston: Jun, 1998. Risk Adjusted Payment Models for the Non-Elderly.
    1. Ash A, Byrne-Logan S. How Well Do Models Work? Predicting Health Care Costs; Proceedings of the Section on Statistics in Epidemiology of the American Statistical Association; Dallas. 1998.
    1. Brown R, Clement DC, Hill JW, et al. Do Health Maintenance Organizations Work for Medicare? Health Care Financing Review. 1993;15(1):7–23. - PMC - PubMed

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