- ACG System
- About Us
- Update / SIgnout
JHQ Online :W5-24 – W5-29.
McKesson Medical Management Group, Newton, MA.
Rising healthcare costs coupled with diminishing financial resources are stimulating changes in the organization and financing of healthcare delivery systems. Government payers (i.e., Medicare and Medicaid) continue to demand more for less. Health plans, faced with the growing cost shift from government programs, are being forced by employers and consumers to reduce costs. Traditionally, health plans have used demographic data such as age and sex as risk adjusters to level the playing field when determining provider payment in risk-pool situations or when setting premiums for employer groups. However, these measures explain less than 5% of the variance in healthcare resource consumption. Recently, case-mix assessment tools, which make use of demographic and/or health status data from claims, are gaining increasing popularity as methods for explaining variations in healthcare utilization and cost for provider groups, employer groups, or physicians’ patient populations for either the same year in which diagnoses were assigned (explanatory or concurrent) or in the future (prospective). The goal is to more equitably compensate providers based on the health status of their patients, as well as to support disease management activities.
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