reports

Adjusted Clinical Groups – an instrument to predict resource use: a population-based healthcare management tool

Gesundheits- und Sozialpolitik 1-2:8-15. Published in German.

Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Advances in information technology, electronic billing, and diagnostic coding provide new opportunities for using computerized healthcare information to measure patients’ health needs and their relationship to healthcare resource consumption.  The Johns Hopkins Adjusted Clinical Group (ACG) case-mix system uses diagnostic information routinely recorded in administrative records, and provides a well-validated assessment of the healthcare resource needs for individuals and, when aggregated, populations.  ACGs were developed in the U.S., and are currently being applied in several other countries.  ACGs group the range and severity of conditions coded on physician claims and hospital records over a defined time period, typically one year.  In North American settings, ACGs explain greater than five-times more healthcare resource use than age and sex groups alone.  This manuscript describes the ACG case-mix system and how it can be used to profile physician financial and quality performance, to adjust payments to physicians or health plans accounting for morbidity of the population, and as a screening tool for high-risk patients enrolled in disease management programs.