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. 2008 Fall;30(1):61-74.

Case selection for a Medicaid chronic care management program

Sharada Weir  1 , Gideon Aweh, Robin E Clark
Affiliations

Case selection for a Medicaid chronic care management program

Sharada Weir et al. Health Care Financ Rev. 2008 Fall.

Abstract

Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality. One challenge is selecting members at risk of costly, preventable service utilization. Using claims data from the State of Vermont, we compare the ability of three pre-existing health risk predictive models to predict the top 10 percent of members with chronic conditions: Chronic Illness and Disability Payment System (CDPS), Diagnostic Cost Groups (DCG), and Adjusted Clinical Groups Predictive Model (ACG-PM). We find that the ACG-PM model performs best. However, for predicting the very highest-cost members (e.g, the 99th percentile), the DCG model is preferred.

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Figures

Figure 1
Figure 1. Evaluation of Model Performance Using the Receiver Operating Characteristics (ROC) Curve: 90th Percentile Cost Threshold
Figure 2
Figure 2. Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold
Figure 3
Figure 3. Percentage of All High-Cost Members Found in Top 10 Percent Risk Group, by Actual Year 2 Cost Threshold
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References

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