Adjusted clinical groups: predictive accuracy for Medicaid enrollees in three states.
Actuarial split-sample method were used to assess predictive accuracy of adjusted clinical groups (ACGs) for Medicaid enrollees in Georgia, Mississippi (lagging in managed care penetration), and California. Accuracy for two non-random groups--high-cost and located in urban poor areas--was assessed. Measures for random groups were derived with and without short-term enrollees to assess the effect of turnover on predictive accuracy. ACGs improved predictive accuracy for high-cost conditions in all States, but did so only for those in Georgia's poorest urban areas. Higher and more unpredictable expenses of short-term enrollees moderated the predictive power of ACGs. This limitation was significant in Mississippi due in part, to that State's very high proportion of short-term enrollees.
Adams
E Kathleen
EK
Rollins School of Public Health, Emory University, Room 656, 1518 Clifton Road NE, Atlanta, GA 30322, USA. eadam01@sph.emory.edu
Bronstein
Janet M
JM
Raskind-Hood
Cheryl
C
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000706:statistics & numerical data*; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D017149:Private Sector; D011336:Probability; D015203:Reproducibility of Results; D013221:State Health Plans / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population