reports

Using the ACG casemix system in population health management programs at Johns Hopkins

BMC Health Serv Res 9:A16.

Johns Hopkins HealthCare, Glen Burnie, MD, USA

  Introduction: Johns Hopkins HealthCare contracts with the US Department  of Defense (DOD) to provide fully capitated healthcare  services to 28,000 DOD beneficiaries. The health  plan is known as the US Family Health Plan (USFHP). In  order to understand and meet the healthcare needs of the  USFHP population, Johns Hopkins HealthCare uses The  ACG® (Adjusted Clinical Group) Casemix System to perform  a population health analysis. It then targets patients  for a variety of population health-management interventions.  Programs such as Health Coaching, Disease Management  and Case Management have been developed and implemented  to help this population improve health, and  reduce healthcare expenditures. The purpose of this presentation  is to:

1) Present the results of the population analyses

2) Review the process for identifying and stratifying appropriate patients for interventions

3) Describe the management programs employed at Johns Hopkins HealthCare

4) Review the results of an intensive case-management program, Guided Care (GC), for patients with multimorbidity

Methods: Population analyses were performed annually to assess  changes in population morbidity over time, and to create  a population-management plan. Additionally, the ACG  diagnostic and pharmacy predictive models were run  monthly to identify and stratify individuals for a variety of  population health-management programs. Health education  and promotion, via books and web-based access to  materials, were offered to patients with the lowest ACG  risk scores.

Patients with moderate risk scores, or a single chronic disease,  were offered health-coaching resources for lifestyle  management to improve their health behaviors. Members  with multiple chronic conditions, and high ACG risk  scores, participated in GC, a nurse-led, patient-centered,  comprehensive chronic-care program delivered in both  the primary-care setting and the patient’s home.

   Results: Annual population analyses showed demographic and  morbidity characteristics of the 28,000 patients. Mean  ACG risk scores by primary care site, number of chronic  conditions, and prevalence of chronic disease compared  to national US benchmarks showed that morbidity is high  in the US Family Health Plan population.

In 2006, we began a cluster-randomized, controlled trial  of Guided Care in the mid-Atlantic region of the United  States. This study was designed to measure the effects of  GC on the quality of care for a multi-morbid population  with high-risk scores on the outcomes of care for patients, families, primary-care practices, physicians, nurses, and healthcare insurers.

We hypothesized that 1) GC would improve patients’  quality of care and physicians’ satisfaction with care  within 6 months, and 2) better quality of care would secondarily  lead to improvements in patients’ quality of life  and efficiency of resource use – as well as to desirable outcomes  for other stakeholders in chronic care.

Preliminary data indicated that Guided Care:

1) Improves the quality of patients’ care. (After six  months, GC patients were twice as likely as regularcare  patients to rate the quality of their care highly.  After 20 months, GC patients were more than twice as  likely as regular-care patients to rate the quality of  their care highly).

2) Reduces the use and cost of expensive services.  (After the first eight months of the study, GC patients  experienced, on average, 24% fewer hospitals days,  37% fewer skilled nursing facility days, 15% fewer  emergency department visits, and 29% fewer home  healthcare episodes. GC patients also experienced 9%  more specialist visits; however, this is not considered  statistically significant. Based on current Medicare  payment rates, and GC costs, these differences in utilization  produce net savings for healthcare payors.)

3) Reduces family caregiver strain. (After six months,  the GC caregivers’ “strain” and “depression” scores  were lower than the comparison (regular care) caregivers’  scores, especially among caregivers who provided  more than 14 hours of weekly assistance.

4) Improves physicians’ satisfaction with chronic care.  (Compared to the physicians in the control group, the  physicians who practiced GC for a year rated their satisfaction  with patient/family communication, and  their knowledge of their chronically-ill patients’ clinical  conditions, significantly higher.

Conclusion: The ACG® Casemix System was used effectively to perform  population health analyses for the US Family Health Plan,  a fully capitated 28,000 member health plan managed by  Johns Hopkins HealthCare. The ACG Predictive Model  identified and stratified the members into appropriate levels  of population health-management intervention programs.  As a program for members with multi-morbidity  and the highest-risk scores, Guided Care improved  patients’ quality of care, physicians’ satisfaction with care,  patients’ quality of life and efficiency of resource use. As well, it led to desirable outcomes for other stakeholders in chronic care.