Comparing alternative methods of targeting potential high-cost individuals for chronic condition management.
OBJECTIVE
To compare the performance of predictive models based on health care claims, health risk assessment (HRA), or both in prospectively identifying high-cost individuals with chronic conditions.


METHODS
Participants included 8056 employees who completed an HRA and were enrolled in a health plan for at least 6 months during the 36-month study period. Two-stage multivariate regression identified predictors of claims cost in four age-by-gender groups.


RESULTS
All models predicted costs effectively, but the combined model performed better (R2 = 0.198 to 0.309) than either the claims-based (R2 = 0.168 to 0.263) or HRA-based model (R2 = 0.125 to 0.205).


CONCLUSIONS
An HRA-based predictive model appears to be a reasonable alternative to claims-based predictive models for identifying individuals for chronic condition management outreach. Where practical, a combined model offers advantages of both approaches and meaningfully increases accuracy.
Anderson
David R
DR
StayWell Health Management, St. Paul, MN 55121, USA.
Mangen
David J
DJ
Grossmeier
Jessica J
JJ
Staufacker
Michael J
MJ
Heinz
Benjamin J
BJ
D000328:Adult; D002908:Chronic Disease / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D005102:Health Expenditures; D006305:Health Status Indicators; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies