DOCUMENTS

Bibliography

The Johns Hopkins ACG® System Bibliography provides links to more than 900 papers and reports from across the globe detailing various studies utilizing the ACG System in a variety of locations, populations, and innovative applications.

Please use the below search box to find articles on specific topics or keywords. You can also use the filters below to refine further.

Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the province of Manitoba

Health Serv Res 37:1345-1364. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada OBJECTIVES: To assess the ability of an […]

Adjusted Clinical Groups: predictive accuracy for Medicaid enrollees in three states

Health Care Financ Rev 24:43-61. Rollins School of Public Health, Emory University, Atlanta, GA, USA Actuarial split-sample method were used to assess predictive accuracy of […]

Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis

BMJ 325:370-371. Health Services Research and Development Center, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA […]

Using selected diagnoses to improve the Chilean capitation formula

Greifswald, Germany: Ernst Moritz Arndt University of Greifswald. Ernst Moritz Arndt University of Greifswald, Greifswald, Germany OBJECTIVES: To contribute to the policy discussion of equity […]

Assessing comorbidity using claims data: an overview

Med Care 40:IV-26-IV-35. Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA Comorbidity, […]

Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs

Med Care 40:717-724. Department of Family and Community Medicine, University of California School of Medicine, Davis, CA, USA BACKGROUND: Previous research shows patient socioeconomic status […]

Patient based ‘burden-of-illness’ in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records

Int J Health Plann Manage 17:269-282. Centre for Development of Health Services, Stockholm County Council, Sweden Patients from one municipality in Sweden utilizing primary health […]

Health-based risk adjustment: application to premium development and profiling

In: Wrightson CW, eds. Financial strategy for managed care organizations: rate setting, risk adjustment, and competitive advantage. Ann Arbor, MI, USA: Health Administration Press:165-225. Health […]

A comparative analysis of claims-based methods of health risk assessment for commercial populations

Minneapolis, MN, USA: Milliman USA and Park Nicollet Institute Health Research Center. Milliman USA and Park Nicollet Institute Health Research Center, Minneapolis, MN, USA The […]

Comparing apples with apples in clinical populations: applications of the Adjusted Clinical Group system in British Columbia

Healthc Manage Forum 15:11-16. Department of Healthcare and Epidemiology, University of British Columbia, Vancouver, BC, Canada This article reviews the Adjusted Clinical Group Case-Mix System […]

Physician-level variation in practice patterns in the VA healthcare system

Health Serv Outcomes Res Methodology 3:95-106. Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, Houston, TX, USA; Baylor College of […]

Is quality free? The relationship between cost and quality across 18 provider groups

Am J Manag Care 8:413-422. HealthPartners Research Foundation, Minneapolis, MN, USA OBJECTIVE: To learn whether the healthcare costs for patients of various care delivery systems […]

Psychiatric illness and subsequent traumatic brain injury: a case control study

J Neurol Neurosurg Psychiatry 72:615-620. Department of Psychiatry, University of Washington, Seattle, WA, USA OBJECTIVE: To determine whether psychiatric illness is a risk factor for […]

Variations in health services utilization by primary care patients

Health Serv Manage Res 15:116-125. Departamento de Estumatologia, Facultad de Odontologia, Universidad de Granada, Campus Univeristario de Cartuja, Granada, Spain This study analyses how both […]

Cost-minimizing risk adjustment

J Health Econ 21:515-530. Center for Health Quality, Outcomes and Economic Research, Boston University School of Public Health, Bedford, MA, USA Conventional risk adjustment, which […]

Process of care for Medicaid-enrolled children with asthma: served by community health centers and other providers

Med Care 40:303-314. Institute for Health Care Research and Policy, Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA OBJECTIVE: To compare the process of […]

Evaluation of diagnosis-based risk adjustment among specific subgroups: can existing adjusters be improved by simple modifications?

Health Serv Outcomes Res Methodology 3:57-73. Academic Technology Center, Bentley College, Waltham, MA, USA; Center for Health Quality, Outcomes and Economic Research, Veterans Administration Medical […]

How profitable is risk selection? A comparison of four risk adjustment models

Health Econ 11:165-174. Department of Health Services, Boston University School of Public Health, Boston, MA, USA To mitigate selection triggered by capitation payments, risk-adjustment models […]

Impacto economico de las enfermedades y pacientes atendidos en atencion primaria adaptacion de los Grupos Clinicos Adjustados (ACGs) en nuestro medio

Barcelona, Spain: University of Barcelona (doctoral dissertation). Published in Spanish. University of Barcelona, Barcelona, Spain El objetivo general de este trabajo es medir el impacto […]

Cost and quality trends in direct contracting arrangements

Health Aff 21:89-102. Health Systems Management Faculty, School of Public Affairs, University of Baltimore, Baltimore, MD, USA. This paper presents the first empirical analysis of […]

Healthcare utilization patterns and risk adjustment under Taiwan’s National Health Insurance system

J Formos Med Assoc 101:52-59. Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taipei, Taiwan BACKGROUND AND PURPOSE: Some […]

A study of population needs-based funding applied to health care and physician services in British Colulmbia

Vancouver, BC, Canada: University of British Columbia (masters thesis). University of British Columbia, Vancouver, BC, Canada The BC Ministry of Health has developed a Population […]

Comorbidity-based payment methodology for Medicaid enrollees with HIV/AIDS

Health Care Financ Rev 23:53-68. Center for Health Program Development and Management, University of Maryland Baltimore County, Baltimore, MD, USA Managed care organizations (MCOs) may […]

Ethnic disparities in care following acute coronary syndromes among Asian Americans and Pacific Islanders during the initial hospitalization

Cell Mol Biol 47:1209-1215. Hawaii Medical Service Association, Care Management, Honolulu, HI, USA Despite the fact that Asian Americans and Pacific Islanders are the fastest […]

Characteristics of adult primary care patients as predictors of future health services charges

Med Care 39:1170-1181. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA BACKGROUND: Utilization risk assessment is potentially useful for allocation […]

Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness.

Pediatrics 108:851-855. University of Virginia Children’s Medical Center, Charlottesville, Virginia, USA OBJECTIVE: Hospital care for children with viral lower respiratory illness (VLRI) is highly variable, […]

Who cares for Medicaid-enrolled children with chronic conditions?

Pediatrics 108:906-912. Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, Boston, MA, USA OBJECTIVE: To estimate generalist, pediatric subspecialist, and any subspecialist […]

Use of risk adjustment in setting budgets and measuring performance in primary care II: advantages, disadvantages, and practicalities

BMJ 323:607-610. School of Public Policy, University College London, London, UK Risk adjustment could help to improve decisions about budgets as well as help measure […]

Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works

BMJ 323:604-607. School of Public Policy, University College London, London, UK No abstract PMID: 11557709 PMCID: PMC55577

Formal risk adjustment by private employers

Inquiry 38:299-309. Department of Economics, Boston University, Boston, MA, USA This paper explores explanations for why few private employers have adopted formal risk adjustment. The […]

Impact of poorly controlled hypertension on healthcare resource utilization and cost

Am J Manag Care 7:389-398. MEDTAP International, Bethesda, MD, USA OBJECTIVE: To examine the relation between blood pressure (BP) control and utilization and cost of […]

Improving the quality of outpatient care for older patients with diabetes: lessons from a comparison of rural and urban communities

J Fam Pract 50:676-680. University of Washington, Department of Family Medicine, Seattle, WA, USA OBJECTIVE: Our goal was to compare the quality of diabetic care […]

Risk adjustment alternatives in paying for behavioral health care under Medicaid

Health Serv Res 36:793-811. UCLA Department of Medicine, Los Angeles, CA, USA OBJECTIVE: To compare the performance of various risk adjustment models in behavioral health […]

Comparison of risk adjusters for Medicaid-enrolled children with and without chronic health conditions

Ambul Pediatr 1:217-224. Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA OBJECTIVE: Several capitation payment […]

Do some physician groups see sicker patients than others? Implications for primary care policy in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Winnipeg, MB, Canada Canadian policy makers are considering a variety of new […]

Hold it – my patients are sicker! The importance of case mix adjustment to practitioner profiles in British Columbia

British Columbia Med J 43:328-333. Ministry of Health and Ministry Responsible for Seniors, Province of British Columbia; UBC Centre for Health Services & Policy Research, […]

Evaluating diagnosis-based case-mix measures: how well do they apply to the VA population?

Med Care 39:692-704. Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, MA, USA BACKGROUND: Diagnosis-based case-mix measures are increasingly used for provider profiling, […]

From theory to application: the implementation of risk adjustment for Minnesota Medicaid

Minneapolis, MN, USA: Park Nicollet Institute, Minnesota Department of Health, Minnesota Department of Human Services. Park Nicollet Institute and Minnesota Department of Health, Minneapolis, MN, […]

Characteristics of risk adjustment systems. Working Paper Series 2

Gainesville, FL, USA: Institute for Child Health Policy, University of Florida. Institute for Child Health Policy, University of Florida, Gainesville, FL, USA Increasing numbers of […]

Characteristics of Maryland residents who obtain health insurance from the small and large group markets

Bethesda, MD, USA: Project Hope Center for Health Affairs. Project Hope, Bethesda, MD, USA This report contains findings from a project conducted by the Project […]

Measuring health status for risk adjusting capitation payments

Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Care Strategies, Hamilton, NJ, USA In this report we describe six health status grouping […]

Risk adjustment for asthma: variations by methodology and implications for providers

Working paper: Informed Purchasing Series. Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Programs Development and Management, University of Maryland, Baltimore County, […]

Implementing risk assessment and risk adjustment for people with disabilities in state programs: six case studies

Washington, DC, USA: NRH Center for Health and Disability Research. NRH Center for Health & Disability Research, Washington, DC, USA As a group, people with […]

The actual versus expected health care use among Healthy Kids enrollees

Gainesville, FL, USA: Institute for Child Health Policy, University of Florida. Institute for Child Health Policy, University of Florida, Gainesville, FL, USA As part of […]

Ambulatory care sensitive hospitalizations and emergency visits: experiences of Medicaid patients using federally qualified health centers

Med Care 39:551-561. MDS Associates, Wheaton, MD, USA BACKGROUND: Federally Qualified Health Centers (FQHCs) serve as regular sources of preventive and primary care for low-income […]

Prevalence of health problems and primary care physicians’ specialty referral decisions

J Fam Pract 50:427-432. Health Services Research and Development Center, Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, […]

Self-referral in point-of-service health plans

JAMA 285:2223-2231. Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA CONTEXT: Most health maintenance organizations offer […]

Use and costs of medical care for children and adolescents with and without attention-deficit/hyperactivity disorder

JAMA 285:60-66. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA CONTEXT: A shortage of data exists on medical care use by persons with […]

L’utilisation des services de sante par les Montrealais atteings de diabete, annees 2001-2002 a 2009-2010

Montreal, QC, Canada: Montreal Health and Social Services Agency. Montreal Health and Social Services Agency, Montreal, QC, Canada No abstract

Performance of the ACG case-mix system in two Canadian provinces.

Med Care 39:86-99. Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada BACKGROUND: While the adjusted clinical group (ACG) system […]

Oil and water? Lessons from Maryland’s effort to protect safety net providers in moving to Medicaid managed care

J Urban Health 77:645-662. Mathematica Policy Research in Washington, DC, USA Studies have highlighted the tensions that can arise between Medicaid managed care organizations and […]

Short-run associations between medical care expenditures and adherence to clinical practice guideline-based measures for diabetes

Value Health 3 Suppl 1:29-38. MEDSTAT Group, Inc., Ann Arbor, MI, USA OBJECTIVES: To estimate relationships between medical care expenditures in 1996 and adherence to […]

Selection bias from requiring patients to give consent to examine data for health services research

Arch Fam Med 9:1111-1118. Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Fairfax, VA, USA BACKGROUND: New rulings nationwide require health services […]

Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians’ offices

JAMA 284:2077-2083. Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA CONTEXT: The US primary care safety net is […]

The faces of Medicaid: the complexities of caring for people with chronic illnesses and disabilities

Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Care Strategies, Hamilton, NJ, USA A complex question has persisted in our minds since […]

Physician referral rates: style without much substance?

Med Care 38:836-846. Department of Family Medicine, University of Rochester, New York, NY, USA BACKGROUND: Primary care physicians (PCPs) exhibit widely varying referral rates, resulting […]

Capitation payment systems – risk factor estimation

Academia Economic Papers 28:231-261. Published in Chinese. PURPOSE: To explore risk factors that can explain individual medical expenditure. SAMPLE: Subjects included in “1996 NHI Satisfaction […]

Updating and calibrating the Johns Hopkins University ACG/ADG risk adjustment method for application to Medicare risk contracting

Final report to Health Care Financing Administration. Baltimore, MD, USA: Johns Hopkins University. Johns Hopkins University, Baltimore, MD, USA The Balanced Budget Act (BBA) of […]

Ambulatory Care Groups as a primary care patient classification system

Cuadernos de Gestión 6:19-24. Published in Spanish. Fundació Jordi Gol i Gurina, Barcelona, Spain No abstract

Health-risk-assessment tools used to predict costs in defined populations

J Healthc Inf Manag 14:31-57. Vanderbilt University Medical Center, Nashville, TN, USA With the Balanced Budget Act of 1997 mandating that the Health Care Financing […]

Risk adjustment lexicon

Reporting Framework Subcommittee of the Steering Committee of the Minnesota ACG Users Group. Revised by Chad Abrams, Terry Bernhardt, Steven Foldes, Jason Wiley, May 17, […]

Provider profiling: doing it right

Healthplan 41:74-79. Medstat Group, Washington, DC, USA Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities […]

Is it necessary that some patients come to see us so often? Factors associated with primary care use in pediatrics

Gac Sanit 14:195-202. Published in Spanish. Centro de Salud de Astrabudúa (Bizkaia), Osakidetza-Servicio Vasco de Salud, Bilbao, Spain OBJECTIVES: To analyze the relationship between pediatric […]

Emergency department use by the rural elderly

J Emerg Med 18:289-297. Department of Family Medicine, University of Washington, Seattle, WA, USA This study uses Medicare data to compare emergency department (ED) use […]

Do physicians who diagnose more mental health disorders generate lower health care costs?

J Fam Pract 49:305-310. University of Rochester School of Medicine, New York, NY, USA BACKGROUND: Underrecognition and undertreatment of mental health disorders in primary care […]

Why do physicians vary so widely in their referral rates?

J Gen Intern Med 15:163-168. Department of Family Medicine, University of Rochester, Rochester, NY, USA OBJECTIVE: To determine which physician practice and psychological factors contribute […]

Risk adjustment of capitation payments to behavioral health care carve-outs: how well do existing methodologies account for psychiatric disability?

Health Care Manag Sci 3:159-169. Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA This study used […]

ACG case-mix system aids contract assessment, improves performance

Data Strateg Benchmarks 4:21-26. The ABCs of ACGs. Adjusted clinical groups, or ACGs, a risk adjustment system developed by Baltimore-based Johns Hopkins University, are being […]

Risk adjusting capitation: applications in employed and disabled populations

Health Care Manag Sci 3:101-109. Department of Health Services, University of Washington, Seattle, WA, USA Risk adjustment may be a sensible strategy to reduce selection […]

The effect of the doctor-patient relationship on emergency department use among the elderly

Am JPublic Health 90:97-102. Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA OBJECTIVES: This study sought to determine the rate […]

Medi-Cal and managed care: risk, costs, and regional variation

Sacramento, CA, USA: Public Policy Institute of California. Rollins School of Public Health, Emory University, Atlanta, GA; School of Public Health, University of Alabama at […]

Risk aversion and costs: a comparison of family physicians and general internists

J Fam Pract 49:12-17. Department of Family Medicine, University of Rochester, New York, NY, USA No abstract Comment in: Interspeciality differences in medical resource utilization. […]

Minimal-burden risk adjusters for the Medicare risk program

Medical College of Virginia Associated Physicians, Mathematica Policy Research. Report prepared for the Health Care Financing Review (HCFA Contract No. 17C-90366/3/01). Washington, DC, USA: Mathematica […]

The development of Ambulatory Care Groups in primary care

Rev Neurol 29:667-669. Published in Spanish. Fundació Jordi Gol i Gurina, Barcelona, España INTRODUCTION: Ambulatory care groups (ACG) are a system of classification for patients […]

Development and estimation of a pediatric chronic disease score using automated pharmacy data

Med Care 37:874-883. Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA BACKGROUND: Although risk assessment models for specific adult populations […]

The Adjusted Clinical Group (ACG) reporting framework

Reporting Framework Subcommittee of the Steering Committee of the Minnesota ACG Users Group. St. Paul, MN, USA: Minnesota ACG Users Group. Minnesota ACG Users Group, […]

Risk distribution and risk assessment among enrollees in Washington state’s Medicaid SSI population

Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Care Strategies, Hamilton, NJ, USA Washington state began enrolling Medicaid SSI (low income, disabled) […]

Description, behavior, use and methodology used to measure case mix in our primary health care system: the Ambulatory Care Groups (ACGs)

Barcelona, Spain: Fundacio Salut, Empresa i Economia. Published in Spanish. Fundacio Salut, Empresa i Economia, Barcelona, Spain No abstract

Risk adjustment and Medicare

New York, NY, USA: Commonwealth Fund. Division of Health Policy Research and Education, Harvard University, Boston, MA, USA Almost all observers agree in principle that […]

Measuring morbidity in populations: performance of the Johns Hopkins Adjusted Clinical Group (ACG) case-mix adjustment system in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Winnipeg, MB, Canada This study examined the performance of the Johns Hopkins […]

Medicaid managed care payment rates in 1998

Health Aff 18:217-227. Urban Institute, Washington, DC, USA This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate […]

The prospective risk adjustment system

J Ambul Care Manage 22:41-52. 3M Health Information Systems, Wallingford, CT, USA The Episode Classification System is intended to perform two tasks. First, it will […]

The duration of ambulatory visits to physicians

J Fam Pract 48:264-271. Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Harvard Medical School, Boston, MA, USA BACKGROUND: The objective of our study […]

Variations in primary care physician referral rates

Health Serv Res 34:323-329. University of Rochester, Rochester, NY, USA OBJECTIVE: To examine primary care physician referral rate variations, including their extent and their stability […]

Application of the Ambulatory Care Groups in the primary care of a European national health care system: does it work?

Med Care 37:238-248. Astrabudúa Health Center, Osakidetza/Basque Health Service, Bizkaia, Spain BACKGROUND: Ambulatory Care Groups (ACGs), a US case mix system that uses the patient […]

Methods of reducing the financial risk of physicians under capitation

Arch Fam Med 8:149-155. Johns Hopkins Center for Hospital Finance and Management, Baltimore, MD, USA. In today’s rapidly changing medical marketplace, managed care plans are […]

Performance of an ambulatory case-mix measurement in primary care in Spain: Ambulatory Care Groups (ACGs)

Eur J Public Health 9:27-35. Unitat d’Investigació Centre del Institut Catalá de la Salut, Barcelona, Spain BACKGROUND: Patient classification systems based on the defining of […]

Methods for analyzing health care utilization and costs

Annu Rev Public Health 20:125-144. Department of Biostatistics, University of Washington, Seattle, WA, USA Important questions about health care are often addressed by studying health […]

The risk-adjustment debate

N Engl J Med 339:1952-1956. Risk adjustment refers to the adjustment of payments to health plans (or to doctors) to reflect more accurately the actual […]

Building health plan databases to risk adjust outcomes and payments

Int J Qual Health Care 10:531-538. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA OBJECTIVES: To highlight the types and sources of […]

Health-based payment and computerized patient record systems

Eff Clin Pract 1:66-72. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA. Health care information technology is changing rapidly and dramatically. A […]

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

Am J Public Health 88:1539-1541. Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA OBJECTIVES: This study examined the effect of continuity […]

The development of a risk-adjusted capitation payment system: the Maryland Medicaid model

J Ambul Care Manage 21:29-52. School of Public Health, Johns Hopkins University, Baltimore, MD, USA This article describes the risk-adjusted payment methodology employed by the […]

The role of provider continuity in preventing hospitalizations

Arch Fam Med 7:352-357. Department of Family and Community Medicine, Christiana Care Health System, Wilmington, DE, USA OBJECTIVES: To examine the association between provider continuity […]

The importance of the data quality in the validation of the ACG case mix

Ambulatory Care Groups. Aten Primaria 22:128. Published in Spanish. Osakidetza Servicio Vasco de Salud, Bizkaia, Spain No abstract Comment on:[A retrospective evaluation of the behaviour […]

Implementing a model for risk distribution among competing health plans

Final report. Princeton, NJ, USA: Robert Wood Johnson Foundation.

Managed care holds down costs, doesn’t hurt quality

Minneapolis Star Tribune, January 3:A13. No abstract

The Florida MediPass program

Chapter 4. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, […]

The New Mexico primary care network

Chapter 5. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, […]

Risk adjustment and rate setting methods in public programs

A report to legislature. St. Paul, MN, USA: Minnesota Department of Health. Health Economics Program, Minnesota Department of Health, St. Paul, MN, USA The 1995 […]

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