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Risk Adjustment Tools for Learning Health Systems: A Comparison of Dx CG and CMS ‐ HCC V21
Author(s) -
Wagner Todd H.,
Upadhyay Anjali,
Cowgill Elizabeth,
Stefos Theodore,
Moran Eileen,
Asch Steven M.,
Almenoff Peter
Publication year - 2016
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12454
Subject(s) - medicaid , pharmacy , medicine , veterans affairs , health care , statistics , actuarial science , gerontology , family medicine , mathematics , business , economics , economic growth
Objective To compare risk scores computed by Dx CG (Verisk) and Centers for Medicare and Medicaid Services ( CMS ) V21. Research Design Analysis of administrative data from the Department of Veterans Affairs ( VA ) for fiscal years 2010 and 2011. Study Design We regressed total annual VA costs on predicted risk scores. Model fit was judged by R ‐squared, root mean squared error, mean absolute error, and Hosmer–Lemeshow goodness‐of‐fit tests. Recalibrated models were tested using split samples with pharmacy data. Data Collection We created six analytical files: a random sample ( n = 2 million), high cost users ( n = 261,487), users over age 75 ( n = 644,524), mental health and substance use users ( n = 830,832), multimorbid users ( n = 817,951), and low‐risk users ( n = 78,032). Principal Findings The Dx CG Medicaid with pharmacy risk score yielded substantial gains in fit over the V21 model. Recalibrating the V21 model using VA pharmacy data‐generated risk scores with similar fit statistics to the Dx CG risk scores. Conclusions Although the CMS V21 and Dx CG prospective risk scores were similar, the Dx CG model with pharmacy data offered improved fit over V21. However, health care systems, such as the VA , can recalibrate the V21 model with additional variables to develop a tailored risk score that compares favorably to the Dx CG models.