The Health Services Research Award was given this year at the National Health Policy conference to Johns Hopkins researchers. Their work lies at the core of current case-mix assessment and risk adjustment. The overall idea is that an assessment of, say, providers' interventions or hospitals' performance must take into account the underlying health status of the population they serve. The methodology has become known as Ambulatory Care Groups or Adjusted Clinical Groups, both with the acronym ACG.
The award summary explains: "The original ICD-diagnosis code based epidemiologic approach for morbidity clustering now includes a wide range of risk, health status and disease measures based on diagnosis, medications, and other input factors derived from insurance claims, encounter/ discharge data and electronic medical records. The ACG software... also incorporates an array of comprehensive predictive modeling algorithms relevant to ambulatory care, hospitalization, and pharmaceutical use." It goes on to describing, at a high level, some of the uses for ACGs. For instance, "ACGs are key to setting risk adjusted capitation payments, global budgets, or incentive payments amounting to tens of billions of dollars annually." In particular, the ACG system has been successfully used for finance/budgeting applications to actuarial underwriting, capitation and resource allocation.
Here is the news release by AcademyHealth, which administers the award.
The Johns Hopkins website on the ACG software can be found here.
Hear Dr. Jonathan Weiner talk about ACGs and risk adjustment in the video below.