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Editorial: Managing costs with software. Advance for Health Information Executives

Advance Newsmagazines, King of Prussia, PA, USA More than two years ago when Dave Ford took over as CEO at CareOregon in Portland, Ore., the […]

Validation and uses of the ACG-DX predictive modeling and risk adjustment tool in an Israeli HMO

Clin Med Res 8:51-52. Maccabi Healthcare Services, Tel Aviv, Israel BACKGROUND: With an ever increasing population of HMO members with chronic disease and continuing economic […]

The additional cost of chronic disease in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada Many Manitobans have a chronic disease—indeed […]

A comparative analysis of methods of health risk assessment: final report

Cambridge, MA, USA: Harvard University School of Public Health. Harvard University School of Public Health, Cambridge, MA, USA A key component of many recent proposals […]

Implementing risk assessment and risk adjustment for people with disabilities in state programs: six case studies

Washington, DC, USA: NRH Center for Health and Disability Research. NRH Center for Health & Disability Research, Washington, DC, USA As a group, people with […]

A comparative analysis of claims-based tools for health risk assessment

Schaumburg, IL, USA: Society of Actuaries. Japanese translation published by Tokyo Gakugei University. Society of Actuaries, Schaumburg, IL, USA This Society of Actuaries research project […]

Capitation payment systems – risk factor estimation

Academia Economic Papers 28:231-261. Published in Chinese. PURPOSE: To explore risk factors that can explain individual medical expenditure. SAMPLE: Subjects included in “1996 NHI Satisfaction […]

Managing the gap: evaluating the impact of Medicaid managed care on service use and disparities in health care access

Baltimore, MD, USA: University of Maryland (doctoral dissertation). University of Maryland, Baltimore, MD, USA The National Institutes of Health (NIH) define a health disparity as […]

Identifying patients with high pharmacy consumption by using the Adjusted Clinical Groups in a primary care setting

European Neuropsychopharmacology 19:S340-S341. Badalona Serveis Assistencials SA, Directorate ofPlanning, Badalona. Barcelona, Spain BACKGROUND: Prescription drug costs are rapidly increasing in most countries. The pharmaceutical expenditure […]

Plataforma de proces de dades d’atencio primaria

Barcelona, Spain: Universitat Politecnica de Catalunya (masters thesis). Published in Catalan. Universitat Politecnica de Catalunya, Spain No abstract

Measuring the casemix of physician practices in primary-care reform models in Ontario, Canada

BMC Health Serv Res 11:A22. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada INTRODUCTION: A number of different blended-payment models for primary- care delivery have […]

Patients with chronic illness in the patient-centered medical home: costs, use, quality and morbidity-based variation

Seattle, WA, USA: University of Washington (doctoral dissertation). University of Washington, Seattle, WA, USA Originally described in 1967 as a central source of a medical […]

Evaluation of the full service family practice incentive program and the practice support program: synthesis report for work completed to June 2013

Victoria, BC, Canada: Hollander Analytical Services Ltd. This report constitutes a synthesis of findings from the evaluation of the Full Service Family Practice Incentive Program […]

Kan casemix-systemer anvendes i den danske primaersektor?

Odense, Denmark: Syddansk Universitet. Published in Danish. Syddansk University, Odense, Denmark Dette arbejdspapir er udarbejdet af Forskningsenheden for Almen Praksis (FEA) og Center for Sundhedsøkonomisk […]

Population-based Study of the Effect of Free Influenza Vaccination on Medical Utilization of Elderly

National Yang Ming University A Population-based Study of the Effect of Free Influenza Vaccination on Medical Utilization of Elderly Taiwanese Ching Wen Chien, Ph.D.

Population risk stratification to support strategic planning and commissioning

NHS Midlands and Lancashire Commissioning Support Unit Population Level Risk Stratification to Support Strategic Planning and Commissioning  

Wednesday(C9)-The Creation of New Models to Predict Future Resource Use and Risk of Hospital Admission for a General Population in NHS England —Stephen Sutch

The Creation of New Models to Predict Future Resource Use and Risk of Hospital Admission for a General Population in NHS England —Stephen Sutch, Johns […]

Tuesday(C7)-Development of the case finding tool using the ACG system-Roberts

Development of the case finding tool using the ACG system Kevin Roberts

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Readmissions: What Health Plans Need to Know

Preventing avoidable hospital readmissions is considered by many to be the most important opportunity for reducing waste in health care. This podcast explains readmissions and why identifying these at-risk patients is important to health plans. Learn more.

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Case Mix Adjustment Case Study – Payer

This Case Study shows how Leicester City CCG, one of the most ethnically diverse areas of the UK, analyzed emergency admission rates for all practices, to learn that practices with lower emergency admission rates had significantly higher coding completeness and GP patient survey scores. Learn more.

Genetics Consultation Rates Following a Diagnosis of High-Grade Serous Ovarian Carcinoma in the Canadian Province of Ontario

Objective: In 2001, the province of Ontario expanded cancer genetic testing eligibility to include all women with high-grade serous ovarian carcinoma (HGSC) of the ovary, […]

Is case-mix adjustment in primary care at the mercy of coding quality? Yes … and no

BACKGROUND:  Primary care clinicians know that case-mix varies between different physician practices and geographical areas. Leicester City Clinical Commissioning Group (CCG) is now able to quantify […]

Effectiveness of a community care management program for multimorbid elderly patients with heart failure in the Veneto Region

Abstract Background The rapidly growing population of elderly subjects with multimorbidity is at risk of receiving fragmented and uncoordinated care, and have frequent hospitalizations and […]

Population risk and burden of health behavioral–related all-cause, premature, and amenable deaths in Ontario, Canada: Canadian Community Health Survey–linked mortality files

Abstract   Purpose To examine the association of all-cause and premature mortality with four modifiable lifestyle behaviors and quantify the burden of behavioral-related premature death in Ontario, […]

An instrumental variable approach quantifies and confirms the duration of pre-transplant dialysis has negative impact on kidney transplant recipient survival

Abstract Dialysis prior to kidney transplantation may have a detrimental effect on post-transplant Outcomes. However, prior studies have not fully characterized the nature of this […]

Interaction between neighborhood walkability and traffic-related air pollution on hypertension and diabetes: The CANHEART cohort

Abstract Background Living in unwalkable neighborhoods has been associated with heightened risk for diabetes and hypertension. However, highly walkable environments may have higher concentrations of […]

Understanding those overdue for cancer screening by five years or more: A retrospective cohort study in Ontario, Canada

Abstract Populations that are more than just slightly overdue for breast, cervical and colorectal screening should likely be targeted for policy and practice interventions. We […]

Association of Patient, Prescriber, and Region With the Initiation of First Prescription of Biologic Disease-Modifying Antirheumatic Drug Among Older Patients With Rheumatoid Arthritis and Identical Health Insurance Coverage

Abstract Importance Prescribing the first biologic treatment for rheumatoid arthritis (RA) is an important decision for patients, their physicians, and payers, with considerable costs and […]

Multimorbidity patterns in patients with heart failure: an observational Spanish study based on electronic health records

Abstract Objectives To characterise the comorbidities of heart failure (HF) in men and women, to explore their clustering into multimorbidity patterns, and to measure the […]

A Revised Classification Algorithm for Assessing Emergency Department Visit Severity of Populations

ABSTRACT Objectives: Analyses of emergency department (ED) use require visit classification algorithms based on administrative data. Our objectives were to present an expanded and revised version […]

Health care service usage and costs for high-needs elderly patients with heart failure

Abstract Background Heart failure (HF) has been defined as global disease of pandemic proportions, since it affects around 26 million people worldwide.[1] According to a recent […]

Personalized prediction of early childhood asthma persistence: A machine learning approach

Abstract Objective Early childhood asthma diagnosis is common; however, many children diagnosed before age 5 experience symptom resolution and it remains difficult to identify individuals […]

Association Between Surgical Approach and Major Surgical Complications in Patients Undergoing Total Hip Arthroplasty

Abstract Objective To determine whether an anterior approach is associated with lower risk of complications than either a lateral or posterior approach. Design, Setting, and […]

Effect of frailty on postoperative readmissions and cost of care for ovarian cancer

Abstract Objectives Frailty, defined as loss of reserve and vulnerability to changes in health, affects many ovarian cancer patients who are planned to undergo surgery. […]

Healthcare resource utilization in myeloproliferative neoplasms: a population-based study from Ontario, Canada

Abstract Background Health resource utilization (HRU) and associated factors of high cost are not well understood in myeloproliferative neoplasms (MPNs). Methods In this population-based, retrospective […]

Impact of Coronary Artery Severity and Revascularization Prior to Transcatheter Aortic Valve Implantation

Abstract Objective The prevalence of coexisting coronary artery disease (CAD) is high in patients who underwent transcatheter aortic valve implantation (TAVI). Our objective was to […]

Stratifying for Value: An Updated Population Health Risk Stratification Approach

Abstract Objective Most risk stratification approaches attempt to predict clinical outcomes rather than value. For a provider organization or health system to have financial success […]

Kidney Function and Potassium Monitoring After Initiation of Renin-Angiotensin-Aldosterone System Blockade Therapy and Outcomes in 2 North American Populations

Abstract Background: Clinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating ACE (angiotensin-converting enzyme) inhibitor or angiotensin II […]

Factors Associated With Nonreceipt of Recommended COPD Medications

Abstract Background COPD medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practice guidelines. Research Question […]

Performance of quantitative measures of multimorbidity: a population-based retrospective analysis

Abstract Background Multimorbidity measures are useful for resource planning, patient selection and prioritization, and factor adjustment in clinical practice, research, and benchmarking. We aimed to […]

Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification Tool

ABSTRACT Objectives To produce an efficient and practically implementable method, based on primary care data exclusively, to identify patients with complex care needs who have […]

Validating and Improving Adjusted Clinical Group’s Future Hospitalization and High-Cost Prediction Models for Dutch Primary Care

Abstract The rise in health care costs, caused by older and more complex patient populations, requires Population Health Management approaches including risk stratification. With risk […]

Understanding Data and Opportunities Focused on Value: A Single-Center Experience in Headache Care

Abstract Background and Objectives Headache syndromes are highly prevalent, disabling, and costly. Our goals were to (1) describe headache care delivery and costs in a […]

Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools

Abstract Background and Aim: In 2021, healthcare expenditure in Italy represented 7.3% of the national gross domestic product, with approximately 80% attributed to the management […]

Is the Barthel index a valid tool for patient selection before urological surgery? A systematic review

Background The Barthel Index (BI) measures the level of patient independence in activities of daily living. This review aims to summarize current evidence on the […]

Gaps in the Hepatitis C Prenatal and Postpartum Care Cascade: Rationale for Treatment in Pregnancy

Abstract Background Hepatitis C virus (HCV) infections have increased among younger populations, including pregnant people. While universal screening guidelines have improved case-finding, studies suggest low […]

Social Risk Factors and Their Effect on Health Care Costs in a Midwestern Health Care System

Abstract Objectives: To assess how social risk factors and socioeconomic status (SES) affect health care costs at a large, integrated health system of 45 clinics […]

Access to primary care is associated with improved long-term survival after severe traumatic injury

ABSTRACT BACKGROUND Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality […]

A cross-sectional analysis of staffing, activity, and patient need in general practice in England in 2023: a retrospective cohort study

Abstract Background: General practice in England is experiencing rising demand, workforce diversification, and widening health inequalities. However, there is limited empirical evidence describing how general […]

A population-based study on the impact of social determinants of health on time to treatment of stage I lung cancer in Ontario, Canada

Abstract Background Timely treatment of Stage I non-small cell lung cancer (NSCLC) is essential to improving outcomes, yet disparities persist in access to treatment across […]

Profiling Hospital Performance Based on Mortality After Transcatheter Aortic Valve Replacement in Ontario, Canada

Abstract Background: Public reporting of hospital-level outcomes is increasingly common as a means to target quality improvement strategies to ensure the delivery of optimal care. […]

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Case Management and Care Coordination Part 2

This webinar will provide an introduction to different types of care programs in use to care for patients with existing and emerging risk and the […]

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Provider Profiling and Engagement

Presented by: Dina Goldberg
Executive Director of Population Health, Innovations and Transformation for JHHC

This webinar describes how Johns Hopkins HealthCare (JHHC) uses Provide Profile Reports, created with data from the ACG System, as part of its comprehensive Provider Engagement Strategy.

Association between use of a health information exchange system and hospital admissions

Appl Clin Inform 5:219-231. Weill Cornell Medical College, New York, NY, USA OBJECTIVE: Relevant patient information is frequently difficult to obtain in emergency department (ED) […]

Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study

Diabet Med 31:806-812. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada AIMS: There is evidence to suggest that mammography rates are decreased in […]

Postoperative medical complications associated with anesthesia in older adults with dementia

J Am Geriatr Soc 62:2102-2109. Queen’s University, Kingston, On, Canada OBJECTIVES: To examine the association between anesthetic technique and postoperative complications in older adults with […]

High-risk case identification for use in comprehensive complex care management

Popul Health Manag 18:15-22. Clalit Health Services, Tel Aviv, Israel The current study aimed to develop a patient selection process for muiltimorbid care management that […]

Paying for primary care: a cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada

Soc Sci Med 124:18-28. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Policy-makers desire an optimal balance of financial […]

Primary care physician panel size and quality of care: a population-based study in Ontario, Canada

Ann Fam Med 14:26-33. University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, […]

Comorbidity: implications for the importance of primary care in ‘case’ management

Ann Fam Med 1:8-14. Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA BACKGROUND: Although comorbidity is […]

Classifying physician practice style: a new approach using administrative data in British Columbia

Med Care 53:276-282. University of British Columbia, Vancouver, BC, Canada; Simon Fraser University, Burnaby, BC, Canada; Access Consulting Ltd, Saskatoon, SK, Canada; University of Alberta, […]

Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence

JAMA Surg :1-9. Western University, London, ON, Canada; Institute for Clinical Evaluative Sciences, London, ON, Canada; Hamad Medical Corporation, Doha, Qatar IMPORTANCE: Synthetic mesh slings […]

Post-discharge intervention in vulnerable, chronically ill patients

J Hosp Med 7:124-130. Oregon Health and Sciences University, Portland VA Medical Center, Portland, OR, USA BACKGROUND: Studies suggest that the inpatient to outpatient transition […]

Patient based ‘burden-of-illness’ in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records

Int J Health Plann Manage 17:269-282. Centre for Development of Health Services, Stockholm County Council, Sweden Patients from one municipality in Sweden utilizing primary health […]

Development and estimation of a pediatric chronic disease score using automated pharmacy data

Med Care 37:874-883. Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA BACKGROUND: Although risk assessment models for specific adult populations […]

Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice

J Clin Endocrinol Metab 92:77-81. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada CONTEXT: Bone density measurement with dual-energy x-ray absorptiometry is widely used […]

The population health approach: health GIS as a bridge from theory to practice

Int J Health Geogr 4:23. Population Health Surveillance Unit, Vancouver Island Health Authority, Victoria, BC, Canada BACKGROUND: The Population Health Approach, proposed by Health Canada, […]

Explanatory ability of the ACG system regarding the utilization and expenditure of the national health insurance population in Taiwan–a 5-year analysis

J Chin Med Assoc 71:191-199. Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, ROC BACKGROUND: The adjusted clinical group (ACG) is […]

Impact of physician assistant care on office visit resource use in the United States

Health Serv Res 43:1906-1922. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA OBJECTIVE: To investigate whether the use of physician […]

Provider profiling: doing it right

Healthplan 41:74-79. Medstat Group, Washington, DC, USA Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities […]

Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women

J Clin Psychopharmacol 31:56-60. Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Independent reports suggest that various psychotropic medications and psychiatric disorders are […]

Health reform, health insurance, and mental health care

Am J Psychiatry 169:675-677. Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation, Washington, DC; Rollins School of Public Health, Emory University, […]

Disease burden in the managed care population at an academic medical center: the effect of adding local partners

Acad Med 80:587-593. University of Michigan Medical School, Ann Arbor, USA. jbilli@umich.edu PURPOSE: Academic medical centers (AMCs) have traditionally cared for the most severely ill […]

Building health plan databases to risk adjust outcomes and payments

Int J Qual Health Care 10:531-538. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA OBJECTIVES: To highlight the types and sources of […]

The changing shape of the physician workforce in prepaid group practice

Health Aff W4:60-63. Permanente Federation, Kaiser Permanente Health Care Program, Oakland, CA, USA Multiple factors have combined to change the size and specialty composition of […]

Does a large-scale organizational transformation toward patient-centered access change the utilization and costs of care for patients with diabetes?

Med Care Res Rev 69:519-539. Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA The authors examined whether Group Health’s […]

A hospital system’s wellness program linked to health plan enrollment cut hospitalizations but not overall costs

Health Aff 32:477-485. University of Arizona, Tucson, AZ, USA Many policy makers believe that health status would be improved and health care spending reduced if […]

Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis

BMJ 325:370-371. Health Services Research and Development Center, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA […]

Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients

Med Care 41:842-852. Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, USA BACKGROUND: Previous research […]

Diffusion into use of exenatide for glucose control in diabetes mellitus: a retrospective cohort study of a new therapy

Clin Ther 29:1784-1794. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA BACKGROUND: Exenatide was approved by the US Food and Drug […]

Efficiency profile in the neurological referrals effectuate reference specialists: use case-mix system Adjusted Clinical Groups

An Med Interna 25:213-221. Published in Spanish. Badalona Serveis Assistencials S.A., Barcelona, Spain OBJECTIVES: To determine the general referral and neurological rate per center and […]

Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines?

Popul Health Manag 13:21-26. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Chronic obstructive pulmonary disease (COPD) […]

Mental health service use before and after diagnosis of early-onset bipolar disorder

J Behav Health Serv 38:398-413. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK To investigate patterns of mental health […]

Potential Medicare savings through prevention and risk reduction

Popul Health Manag 14 Suppl 1:S35-S44. Healthways Center for Health Research, Franklin, TN, USA Medicare is challenged to maintain solvency as enrollment climbs because of […]

The relationship between financial incentives and quality of diabetes care in Ontario, Canada

Diabetes Care 35:1038-1046. Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, […]

Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare

Aten Primaria 44:348-357. Published in Spanish. Badalona Serveis Assistencials, Badalona, Barcelona, Spain OBJECTIVE: To compare three methods of measuring multiple morbidity according to the use […]

Heart failure in primary care: co-morbidity and utilization of health care resources

Fam Pract 30:520-524. Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain BACKGROUND: In order to ensure proper management of primary […]

Risk-stratification methods for identifying patients for care coordination

Am J Manag Care 19:725-732. Mayo Clinic, Rochester, MN, USA BACKGROUND: Care coordination is a key component of the patient-centered medical home. However, the mechanism […]

Predictors of short-term postoperative survival after elective colectomy in colon cancer patients >/= 80 years of age

Ann Surg Oncol 20:1427-1435. Department of Surgery, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA BACKGROUND: Individuals ≥ 80 years of age […]

Movement disorders in elderly users of risperidone and first generation antipsychotic agents: a Canadian population-based study

PLoS One 8:e64217. Faculty of Pharmacy, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Despite concerns over the potential for severe adverse events, antipsychotic medications remain […]

Patient and Physician Factors Associated With Pulmonary Function Testing for COPD: A Population Study

Chest 145:272-281. Institute for Clinical Evaluative Sciences; Sunnybrook Research Institute; Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada BACKGROUND: The diagnosis of COPD […]

Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data

Am J Manag Care 10:783-790. HSI Network LLC, USA OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance […]

The meaningful use of electronic health records and health care quality

Am J Med Qual 30:512-519. Weill Cornell Medical College, New York, NY, USA The federal government is investing approximately $30 billion in incentives for adoption […]