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Save the date! ACG System User Conference October 26-28, 2025

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Addition of pharmacy cost data improves performance of the Adjusted Clinical Groups predictive model for total health care costs overall and within disease specific groups

Value in Health 7:371. AdvancePCS, Hunt Valley, MD, USA OBJECTIVE: To determine the effect of adding the pharmacy cost data option to the Adjusted Clinical […]

Burden of morbidity in a patient perspective – the case of sick-leave certified patients in primary care

BMC Public Health 9:157. Data on morbidity in Sweden are based on numbers of diagnoses, classified by the WHO system, the International Statistical Classification of […]

Using risk adjustment approaches in child welfare performance measurement: applications and insights from health and mental health settings

Child Youth Serv Rev 32:103-112. Washington University in St. Louis, St. Louis, MO, USA Federal policymaking in the last decade has dramatically expanded performance measurement […]

Predicting the financial risks of seriously ill patients

Sacramento, CA, USA: California Health Care Foundation. In this paper, a Medical Productivity Index (MPI) is proposed as such a metric to capture the value […]

Empirical studies in the economics of health insurance, health, and fertility

Princeton, NJ, USA: Princeton University (doctoral dissertation) Princeton University, Princeton, NJ, USA This thesis is a collection of essays in the economics of health insurance, […]

A simple but efficient approach to the analysis of multilevel data

Health Economics Papers 2013:6. Odense, Denmark: University of Southern Denmark. University of Southern Denmark, Odense, Denmark Much research in health economics revolves around the analysis […]

Adjusted clinical groups: a patient classification system through risk adjustment

Rev Peru Med Exp Salud Publica 30:308-314. Published in Spanish. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain Adjusted Clinical Groups (ACG) are risk […]

High-Risk Case Identification for Use in Comprehensive Complex Care Management

  High-Risk Case Identification for Use in Comprehensive Complex Care Management Because patients with multiple chronic conditions require proactive, coordinated care management to effectively manage […]

Population Health Management through Care Coordination and Interventions

Population health management at JHHC represents a comprehensive approach to health care considering the distribution of health outcomes within a population, and the health determinants […]

Casemix and Quality

Hospital Authority Casemix and Quality – Are they rivals or partners? Dr. K.H. Lee

Tuesday-Managing hospitalization risk-Terry and Oberg

Dovetail Managing Hospitalization Risk: Refining Patient Selection in a Care Transitions Program Lara Terry, MD. Jeff Oberg

Monday-US Health Reform-Abrams

Johns Hopkins ACG System Using ACGs to Support Risk Adjusted Premiums within the Health Insurance Exchange Chad Abrams

Monday-Advances in modeling risk-Thibodeau

Medica Leveraging the John Hopkins ACG Tool to Support Total Cost of Care Contracts Peter M. Thibodeau

Implementing the ACG risk within NHS

NHS Airedale, Bradford & Leeds Cluster Information Services Implementing the ACG risk of hospitalization model with NHS data: experiences from Leeds Dr Thomas Mason MA., […]

Using Predictive Modeling to Identify Readmission Risk

Johns Hopkins Bloomberg School of Public Health Using Predictive Modeling to Identify Readmission Risk K. Lemke

Monday(C3)-Geographically Identifying Expanded Diagnosis Clusters in the Hispanic/Latino Population —Thomas Ludden

Geographically Identifying Expanded Diagnosis Clusters in the Hispanic/Latino Population  —Thomas Ludden, Carolinas Healthcare System  

Wednesday(C9)-Swinging from a new tee – towards ‘The Extended Epidemiology’ by analysing the outcome from ACG processing in a County Council in Sweden

Swinging from a new tee – towards ‘The Extended Epidemiology’ by analysing the outcome from ACG processing in a County Council in Sweden —Ulf Börjesson, […]

Care Density: Amy Salls, DST Health Solutions

ACG System DST Health Solutions Care Density Amy Salls

The ACG System as a Common Language

Chad Abrams, Director of U.S. Operations, ACG System; describes common challenges around the world such as language differences, data quality, turning data into impact, and […]

Segmentation Case Study

Slough Clinical Commissioning Group (CCG), which covers a population of 143,000 in the UK, used the Johns Hopkins ACG System to conduct a population health analysis that generated several new insights. After just 18 months, unplanned hospitalizations were reduced by 18% and emergency department visits were reduced by 19%.

Association of Suicidality and Depression With 5α-Reductase Inhibitors

IMPORTANCE There have been concerns raised by patients and regulatory agencies regarding serious psychiatric adverse effects associated with 5α-reductase inhibitors. OBJECTIVE To determine if there […]

Estimates and predictors of health care costs of esophageal adenocarcinoma: a population-based cohort study

Background Esophageal adenocarcinoma (EAC) incidence is increasing rapidly. Esophageal cancer has the second lowest 5-year survival rate of people diagnosed with cancer in Canada. Given […]

Equilibria in Health Exchanges: Adverse Selection versus Reclassification Risk

Abstract This paper studies regulated health insurance markets known as exchanges, motivated by the increasingly important role they play in both public and private insurance […]

Impact of stratification on the effectiveness of a comprehensive patient‐centered strategy for multimorbid patients

Abstract Objective The objective of this work was to assess the effectiveness of a population‐level patient‐centered intervention for multimorbid patients based on risk stratification for […]

Physician procedure volume and related adverse events after surgically induced abortion: a population-based cohort study

Abstract   BACKGROUND Induced abortion is a common procedure performed by physicians with varying degrees of clinical experience. We aimed to determine whether a physician’s […]

A comparison of population segmentation methods

Abstract This paper presents the first comparison of descriptive segmentation methods for population health management. The aim of descriptive segmentation is to identify heterogeneous segments […]

Determinants of vaccination uptake, and influenza vaccine effectiveness in preventing deaths and hospital admissions in the elderly population; Treviso, Italy, 2014/2015-2016/2017 seasons

ABSTRACT Seasonal influenza is an important cause of morbidity and mortality, particularly among the elderly population. Determinants of vaccination uptake and its impact on health […]

Colonoscopy resource availability and its association with the colorectal cancer diagnostic interval: A population-based cross-sectional study

Abstract BACKGROUND Colonoscopy is a key resource used to diagnose colorectal cancer (CRC). This study evaluated the relationship between colonoscopy availability and the length of […]

A systematic review of case-mix models for home health care payment: Making sense of variation

Abstract Background Case-mix based payment of health care services offers potential to contain expenditure growth and simultaneously support needs-based care provision. However, limited evidence exists […]

Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting

Abstract   Background Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated […]

Factors associated with waiting time to breast cancer diagnosis among symptomatic breast cancer patients: a population-based study from Ontario, Canada

Abstract Purpose A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a […]

Assessment of the Adjusted Clinical Groups system in Dutch primary care using electronic health records: a retrospective cross-sectional study

Abstract Background Within the Dutch health care system the focus is shifting from a disease oriented approach to a more population based approach. Since every […]

Association of perioperative red blood cell transfusions with all-cause and cancer-specific death in patients undergoing surgery for gastrointestinal cancer: Long-term outcomes from a population-based cohort

Abstract Background Red blood cell transfusions are common in patients undergoing gastrointestinal cancer surgery. Yet, to adequately balance their risks and benefits, clinicians must understand […]

Incidence of Access to Ambulatory Mental Health Care Prior to a Psychiatric Emergency Department Visit Among Adults in Ontario, 2010-2018

Abstract Importance Psychiatric emergency department (ED) visits may be avoidable if individuals have access to adequate outpatient care, but the extent to which individuals use […]

Healthcare utilization in patients with higher-risk MDS/low-blast count AML treated with azacitidine in the ‘real-world’

Abstract Background Despite the adoption of azacitidine (AZA) in higher-risk MDS/low-blast count AML, limited ‘real-world’ data on resource utilization and toxicity exist. Methods We linked […]

Association between Dysphagia and Surgical Outcomes across the Continuum of Frailty

Abstract Objective This study examined the relationship between dysphagia and adverse outcomes across frailty conditions among surgical patients ≥50 years of age. Methods A retrospective cohort […]

Allopurinol adherence, persistence and patterns of use in individuals with diabetes and gout: A retrospective, population-based cohort analysis

Abstract Objective There has been growing interest in the potential role for allopurinol to reduce cardiovascular events in people with diabetes. While adherence to allopurinol is poor […]

Multimorbidity Patterns in the General Population: Results from the EpiChron Cohort Study

Abstract Objective The correct management of patients with multimorbidity remains one of the main challenges for healthcare systems worldwide. In this study, we analyze the […]

Assessing the Value of Unsupervised Clustering in Predicting Persistent High Health Care Utilizers: Retrospective Analysis of Insurance Claims Data

Abstract Background A high proportion of health care services are persistently utilized by a small subpopulation of patients. To improve clinical outcomes while reducing costs […]

Impact of a high-risk multimorbidity integrated care implemented at the public health system in Chile

Abstract During recent years, multimorbidity has taken relevance because of the impact of causes in the system, people, and their families, which has been a […]

A bias evaluation checklist for predictive models and its pilot application for 30-day hospital readmission models

Abstract Objective Health care providers increasingly rely upon predictive algorithms when making important treatment decisions, however, evidence indicates that these tools can lead to inequitable […]

Latent Class Analysis of Social Needs in Medicaid Population and Its Impact on Risk Adjustment Models

Abstract Background: A growing number of US states are implementing programs to address the social needs (SNs) of their Medicaid populations through managed care contracts. […]

Differences in use of telemedicine integrated into traditional primary health care – a comparative observational study

Abstract Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend […]

Risk Stratification with only EHR Data – White Paper

Risk stratification models have traditionally used medical and pharmacy claims data combined with other sources, such as electronic health records (EHRs).  But provider organizations often […]

Reducing Emergency Department Use

People usually go to the Emergency Department (ED) when they are experiencing a medical emergency. But some people choose the ED for non-urgent care, which […]

Case Mix Measurement

This webinar provides an introduction to the principle of case mix and the constructs within the ACG System that make this possible. This session is a […]

Applications of the ACG System in the UK

This white paper provides an overview of the ACG System and how it is being used to support a range of clinical and commissioning activities […]

Physician referral rates: style without much substance?

Med Care 38:836-846. Department of Family Medicine, University of Rochester, New York, NY, USA BACKGROUND: Primary care physicians (PCPs) exhibit widely varying referral rates, resulting […]

Constructing ”behavioral” comparison groups: a difference-in-difference analysis of the effect of copayment based on the patient’s price elasticity

Eval Health Prof 37:434-456. National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan It is well known that the differences-in-differences (DD) estimator is based […]

Revisiting the economic efficiencies of observation units

Manag Care 24:46-52. University of Texas, Houston, TX, USA; Michael E. DeBakey Veterans Affairs Medical Center HSR&D, Houston, TX, USA; Baylor College of Medicine, Houston, […]

Profiling resource use: do different outcomes affect assessments of provider efficiency?

Am J Manag Care 8:1105-1115. Center for Health Quality, Outcomes and Economic Research, Bedford Veterans Affairs Medical Center, Bedford, MA, USA OBJECTIVES: To examine whether […]

The case for case-mix adjustment in practice profiling. When good apples look bad

JAMA 272:871-874. Harvard Community Health Plan, Brookline, MA, USA OBJECTIVE: To assess the influence of patient characteristics on practice profiling. Using the example of specialty […]

The patient-centered medical home and associations with health care quality and utilization: a 5-year cohort study

Ann Intern Med 164:395-405. Weill Cornell Medical College, New York, NY, USA BACKGROUND: Effects of the patient-centered medical home (PCMH) are unclear. Previous studies had […]

A population-based study evaluating family physicians’ HIV experience and care of people living with HIV in Ontario

Ann Fam Med 13:436-445. Bruyère Research Institute, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Institute for […]

Sex disparities in post-acute myocardial infarction pharmacologic treatment initiation and adherence: problem for young women

Circ Cardiovasc Qual Outcomes 8:586-592. University of British Columbia, Vancouver, BC, Canada BACKGROUND: The prevalence of the use of secondary prevention cardiovascular medications is lower […]

Increased surgeon experience with rheumatoid arthritis reduces the risk of complications following total joint arthroplasty

Arthritis Rheumatol 66:488-496. University of Toronto and Women’s College Hospital, Toronto, ON, Canada OBJECTIVE: To determine the relationship between surgeon experience with, and complications following, […]

Prevalence, expenditures, and complications of multiple chronic conditions in the elderly

Arch Intern Med 162:2269-2276. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA BACKGROUND: The prevalence, health care […]

Ambulatory care groups: a categorization of diagnoses for research and management

Health Serv Res 26:53-74. Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA This article describes a […]

Using the Johns Hopkins aggregated diagnosis groups (ADGs) to predict mortality in a general adult population cohort in Ontario, Canada

Med Care 49:932-939. Institute for Clinical Evaluative Sciences, Department of Health Management, Policy and Evaluation, University of Ottawa, Ottawa, ON, Canada BACKGROUND: Administrative healthcare databases […]

Preventable hospitalizations and socioeconomic status.

Health Aff 17:177-189. Wagner Graduate School, New York University, New York, NY, USA. “Preventable” hospitalizations have been proposed as indicators of poor health plan performance. […]

Applying diagnosis and pharmacy-based risk models to predict pharmacy use in Aragon, Spain: the impact of a local calibration

BMC Health Serv Res 10:22. Aragon Health Science Institute, Zaragoza, Spain BACKGROUND: In the financing of a national health system, where pharmaceutical spending is one […]

Ambulatory Care Groups and the profiling of primary care physician resource use: examining the application of case mix adjustments

J Ambul Care Manage 19:86-89. Center for Research in Ambulatory Health Care Administration, Englewood, CO, USA A variety of profiling models and tools is utilized […]

Ambulatory specialist use by nonhospitalized patients in us health plans: correlates and consequences

J Ambul Care Manage 32:216-225. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Approximately 7 of 10 (and 95% of the elderly) people […]

Impact of comorbidity on the individual’s choice of primary health care provider

Scand J Prim Health Care 29:104-109. Lund University, Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Malmö, Sweden OBJECTIVE. This study examined whether age, […]

Comparing asthma care provided to Medicaid-enrolled children in a primary care case manager plan and a staff model HMO

Ambul Pediatr 3:253-262. Health Policy Institute, Georgetown University, Washington, DC, USA OBJECTIVE: To examine differences in selected processes of asthma care provided to Medicaid-enrolled children […]

Economic profiling of primary care physicians: consistency among risk-adjusted measures

Health Serv Res 39:985-1003. Health Management and Policy, University of Michigan, Ann Arbor, MI, USA OBJECTIVE: To investigate whether different risk-adjustment methodologies and economic profiling […]

Access intervention in an integrated, prepaid group practice: effects on primary care physician productivity

Health Serv Res 43:1888-1905. Department of Health Services, University of Washington, Seattle, WA, USA OBJECTIVE: To estimate the joint effect of a multifaceted access intervention […]

Risk classification of adult primary care patients by self-reported quality of life

Med Care 43:189-193. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA BACKGROUND: Although patient-reported health-related quality of life (HRQOL) is […]

Sleep complaints and their association with comorbidity and health-related quality of life in an older population in Sweden

Aging Ment Health 15:204-213. School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden OBJECTIVE: The relationship between sleep complaints, comorbidity and health-related quality of […]

Patients with atrial fibrillation and an alternative primary diagnosis in the emergency department: a description of their characteristics and outcomes

Acad Emerg Med 20:193-199. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada OBJECTIVES: Atrial fibrillation is common in the emergency department (ED). Mortality rates at […]

Physical activity and influenza-coded outpatient visits, a population-based cohort study

PLoS One 7:e39518. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Although the benefits of physical activity in preventing chronic medical conditions are well […]

Risk adjustment of capitation payments to behavioral health care carve-outs: how well do existing methodologies account for psychiatric disability?

Health Care Manag Sci 3:159-169. Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA This study used […]

Pharmaceutical use among older adults: using administrative data to examine medication-related issues

Can J Aging 24 Suppl 1:81-95. Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada Medication use is […]

The effects of complications and comorbidities on the quality of preventive diabetes care: a literature review

Popul Health Manag 11:217-218. Mathematica Policy Research, Washington, DC, USA Although concurrent conditions such as complications and comorbidities are common in people with diabetes, both […]

Cost of arterial hypertension according to levels of morbidity in primary care setting

Med Clin (Barc) 133:290-295. Published in Spanish. Dirección de Planificación, Badalona Serveis Assistencials SA, Badalona, Barcelona, España BACKGROUND AND OBJECTIVE: To determine the health care […]

Case study: the Minneapolis Buyers Health Care Action Group

Inquiry 35:171-177. Health Research Center, Institute for Research and Education, Health System Minnesota, Minneapolis, MN, USA Managed care plans are a type of health insurance. They […]

Physician and patient factors associated with follow up of high grade dysplasias of the cervix: a population-based study

Gynecol Oncol 120:63-67. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada OBJECTIVE: This population-based study characterizes available physician […]

Comparative ability of comorbidity classification methods for administrative data to predict outcomes in patients with chronic obstructive pulmonary disease

Ann Epidemiol 22:881-887. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada PURPOSE: Administrative healthcare databases are used for health services research, comparative effectiveness studies, and […]

Review of methods used to measure comorbidity in cancer populations: no gold standard exists

J Clin Epidemiol 65:924-933. Cancer Control and Screening Research Group, Department of Public Health, University of Otago, Wellington South, New Zealand OBJECTIVE: This article reviews […]

Evaluating early repeat emergency department use in patients with atrial fibrillation: a population-based analysis

Am Heart J 165:939-948. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada BACKGROUND: Emergency department (ED) use by patients with atrial fibrillation is high and […]

Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study

J Gen Intern Med 28:386-391. Office of Women’s Health, Mayo Clinic, Rochester, MN, USA BACKGROUND: Patients requiring interpreters may utilize the health care system differently […]

Association between metformin therapy and mortality after breast cancer: a population-based study

Diabetes Care 36:3018-3026. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada OBJECTIVE: Metformin has been associated with a reduction in breast cancer risk […]

Primary care doctors’ opinion on a risk adjustment system: Adjusted Clinical Groups

Rev Peru Med Exp Salud Publica 30:345-347. Published in Spanish. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain No abstract

Impact of rheumatoid arthritis on receiving a diagnosis of hypertension among patients with regular primary care

Arthritis Care Res Department of Medicine, Rheumatology Division, University of Wisconsin, Madison, WI, USA OBJECTIVE: Despite numerous studies reporting increased cardiovascular disease (CVD) in patients […]

Comorbidity of dementia: a cross-sectional study of primary care older patients

BMC Psychiatry 14:84. EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), University Hospital, Zaragoza, Spain BACKGROUND: The epidemiologic study of comorbidities of […]

The impact of morbidity trajectories on identifying high-cost cases: using Taiwan’s National Health Insurance as an example

J Public Health 36:300-307. Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. BACKGROUND: Incorporating longitudinal information […]

Exploring the Johns Hopkins Aggregated Diagnosis Groups in administrative data as a measure of child health

This study explored the utility of the Johns Hopkins Aggregated Diagnostic Groups (ADGs) as a noncategorical measure of child health in administrative health data. Canadian […]

The hassle of wellness: do peers and health status matter?

In: Population Association of America, eds. 2014 Annual Meeting, Population Association of America. Princeton, NJ, USA: Population Association of America. Cornell University, Ithaca, NY, USA […]

A data-driven approach towards patient identification for telehealth programs

2015 IEEE International Conference on Big Data :2551-2559. Robert Bosch (US), Palo Alto, CA, USA Telehealth provides an opportunity to reduce healthcare costs through remote […]

An actuarial perspective on healthcare expenditure in the last year of life

Washington, DC: International Congress of Actuaries. University of Cape Town, South Africa The aim of this paper is to highlight the key methodological considerations in […]

A hierarchical multivariate two-part model for profiling providers’ effects on health care changes

J Am Statistical Assoc 101:911-923. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Procedures for analyzing and comparing health care providers’ effects on […]

Risk adjustment in state Medicaid programs

Health Watch :14-17, 32-34. Denver, Colorado, office of Wakely Consulting Group This article discusses some of the most important considerations in implementing risk adjustment within […]

Health-based risk adjustment: application to premium development and profiling

In: Wrightson CW, eds. Financial strategy for managed care organizations: rate setting, risk adjustment, and competitive advantage. Ann Arbor, MI, USA: Health Administration Press:165-225. Health […]

Evaluation of casemix adjustment methods for the Massachusetts Division of Medical Assistance

Massachusetts Rate Setting Commission. Final report and recommendation. Boston, MA, USA: Massachusetts Rate Setting Commission. Massachusetts Rate Setting Commission, Boston, MA, USA We investigated methods […]

How well do models work? Predicting health care costs

In: American Statistical Association, eds. Proceedings of the Section on Statistics in Epidemiology. Alexandria, VA, USA: American Statistical Association:42-49. Department of General Internal Medicine, Boston […]

A risk stratification model for adult patients with obstructive sleep apnea: development and evaluation

Toronto, ON, Canada: Institute for Clinical Evaluative Sciences. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada STUDY HYPOTHESES: We hypothesize that the apnea-hypopneas index (AHI), […]

Studying effects of primary care physicians and patients on the trade-off between charges for primary care and specialty care using a hierarchical multivariate two-part model

Department of Biostatistics Working Paper 51. Baltimore, MD, USA: Johns Hopkins University. Johns Hopkins University, Baltimore, MD, USA OBJECTIVE. To examine effects of primary care […]

An incentive mechanism for using risk adjuster to reimburse health care provider

York, UK: University of York. University of York, York, UK Health care providers are almost always universally reimbursed by third party purchasers. As a result, […]

Prompt reduction in use of medications for comorbid conditions after bariatric surgery

Rockville, MD, USA: Agency for Healthcare Research and Quality. Johns Hopkins University, Baltimore, MD, USA BACKGROUND. Bariatric surgery leads to weight loss, but it is […]

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