Challenges to identifying actual diabetes case-mix complexity and total treatment charges.
Patient management programs are being used to improve the quality of care and decrease charges for both high-cost and potential high-cost claimants. Adequate information is key to program development, planning, and implementation. Claims-based data are a ready source of valuable information, but without proper processing, true case-mix complexity and total charges for patients will not be identified.
Baker
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Practice Patterns Science, Maryland Heights, MO, USA.
Ertle
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Cave
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DG
D016000:Cluster Analysis; D015897:Comorbidity; D003363:Cost Control; D003625:Data Collection; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data*; D019468:Disease Management; D017048:Health Care Costs; D006801:Humans; D007345:Insurance Claim Review; D011787:Quality of Health Care; D014481:United States