papers

Risk-stratification methods for identifying patients for care coordination

Am J Manag Care 19:725-732.

Mayo Clinic, Rochester, MN, USA

BACKGROUND: Care coordination is a key component of the patient-centered medical home. However, the mechanism for identifying primary care patients who may benefit the most from this model of care is unclear.

OBJECTIVES: To evaluate the performance of several risk-adjustment/stratification instruments in predicting healthcare utilization.

STUDY DESIGN: Retrospective cohort analysis.

METHODS: All adults empaneled in 2009 and 2010 (n = 83,187) in a primary care practice were studied. We evaluated 6 models: Adjusted Clinical Groups (ACGs), Hierarchical Condition Categories (HCCs), Elder Risk Assessment, Chronic Comorbidity Count, Charlson Comorbidity Index, and Minnesota Health Care Home Tiering. A seventh model combining Minnesota Tiering with ERA score was also assessed. Logistic regression models using demographic characteristics and diagnoses from 2009 were used to predict healthcare utilization and costs for 2010 with binary outcomes (emergency department [ED] visits, hospitalizations, 30-day readmissions, and high-cost users in the top 10%), using the C statistic and goodness of fit among the top decile.

RESULTS: The ACG model outperformed the others in predicting hospitalizations with a C statistic range of 0.67 (CMS-HCC) to 0.73. In predicting ED visits, the C statistic ranged from 0.58 (CMSHCC) to 0.67 (ACG). When predicting the top 10% highest cost users, the performance of the ACG model was good (area under the curve = 0.81) and superior to the others.

CONCLUSIONS: Although ACG models generally performed better in predicting utilization, use of any of these models will help practices implement care coordination more efficiently.