Medication, diagnostic, and cost information as predictors of high-risk patients in need of care management.
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.
Forrest
Christopher B
CB
Department of Pediatrics, Children's Hospital of Philadelphia, 3400 Civic Center Blvd, ABR 1335, Philadelphia, PA 19104, USA. forrestc@email.chop.edu
Lemke
Klaus W
KW
Bodycombe
David P
DP
Weiner
Jonathan P
JP
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