Risk scores have long been a focus among health care systems for calculating the disease burden of a specific member or population. While these scores are vital to understanding annual expenditures, there is often more information to be considered about an individual, beyond their risk score.

The Johns Hopkins ACG^® System calculates risk scores in the same manner as many other population health software systems. However, with the ACG System’s predictive modeling and resource allocation capabilities, the additional data available to System users greatly surpasses what they may find when only measuring risk score. Today, we look at why you should look beyond the risk score … in order to have a full picture of your population’s overall health.

The Patient is More than Just a Number

To understand risk scores, you must first know what they measure. Risk scores are a numerical representation of how much a single patient may cost a facility in the future. And while it’s necessary for a hospital or health plan to focus on this metric to calculate cost and savings, there are many other factors that can contribute to an individual’s overall disease burden. Risk scores alone do not serve as a clear indicator of a person’s morbidity. The ACG System’s person-centered approach gives a more complete view of the spectrum of health care resources an individual may need over their lifetime.

Other Factors Can Influence Overall Health

Recently, with the release of ACG v13.0, we’ve shared a lot of information about Social Determinants of Health and social needs. These factors influence everyday life and impact individual health, both positively and negatively. While risk scores accurately predict a patient’s financial burden, they fail to capture information on situations such as homelessness, lack of education and lack of transportation.

The ACG System considers these SDoH factors and applies them, in order for users to gain a full understanding of the issues a patient or population faces. This additional information can help drive investments in the community or other tactical support to assist a patient or population that lacks basic needs. In short, the ACG System helps users make sense of and create strategies for improving population health.

Human Error Can Miss Critical Details

Medical coding mistakes are often simple human error, but they can cause an avalanche of problems. Assigning the wrong ICD-10 code to a procedure or diagnosis can result in a denied claim or an incorrect payment. When you consider risk scores, a coding error may result in a misunderstanding of the full scope of a patient’s disease burden.

The ACG System has built-in tools that help compensate for these errors. Features such as Rx-Defined Morbidity Groups (Rx-MGs) and Aggregated Diagnosis Groups (ADGs) work together to help predict the need for health care services over time. Patients are more accurately categorized by their medication patterns or diagnoses to indicate morbidity, instead of a single code that may or may not be correct.

What sets the ACG System apart?

The ACG System enables users to enhance patient targeting and correctly assess risk. The System also considers several additional factors to arrive at a more comprehensive risk score that sees the whole patient, rather than an over-simplified representation of their disease burden. By using the ACG System, your organization will gain understanding about predicted risk while providing patient-centered care. To learn more about what sets the ACG System apart from other risk models, click here.

If you have any questions or want to learn more about the ACG System, please email us at acgsupport@jh.edu. If you are an existing ACG System customer, please contact your account manager.