title: Medication, diagnostic, and cost information as predictors of high-risk patients in need of care management.
abstract: OBJECTIVE
  To contrast the advantages and limitations of using medication, diagnostic, and cost data to prospectively identify candidates for care management programs.
  
  
  METHODS
  Risk scores from prior-cost information and a set of clinically based predictive models (PMs) derived from diagnostic and medication data sources, as well as from a combination of all 3 data sources, were assigned to a national sample of commercially insured, non-elderly adults (n = 2,259,584). Clinical relevance of risk groups and statistical performance using future costs as the outcome were contrasted across the PMs.
  
  
  RESULTS
  Compared with prior cost, diagnostic and medication-based PMs identified high-risk groups with a higher burden of clinically actionable characteristics. Statistical performance was similar and in some cases better for the clinical PMs compared with prior cost. The best classification accuracy was obtained with a comprehensive model that united diagnostic, medication, and prior-cost risk factors.
  
  
  CONCLUSIONS
  Clinically based PMs are a better choice than prior cost alone for programs that seek to identify high-risk groups of patients who are amenable to care management services.
authors.affiliation: Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Blvd, ABR 1335, Philadelphia, PA 19104, USA. forrestc@email.chop.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Lemke
authors.forename: David P
authors.initials: DP
authors.lastname: Bodycombe
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Weiner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D020380:Needs Assessment; D010346:Patient Care Management; D011446:Prospective Studies; D055815:Young Adult