Enrollment – Questionnaire; assign information such as significant pain/ lack of control/knowledge associated with chronic illness.
Tracking of Enrollees over time and predicting which are receiving under (risk management index) / over service (care management index).
Quality improvement opportunities (care management index) for each type of health care encounter.
Tracking of smaller group of enrollees projected to be high cost but are not at the present time.
Retrospective analysis of same individuals to identify missed opportunities.
Keeping people healthier
Prospective Clinical Modeling
The increased precision can best be done in a “categorical” or “drg-like” approach as opposed to a regression model. A regression model will simply pick up the “expensive” medications and predict high outlays.
A categorical model can distinguish between costs that are “avoidable” and unavoidable. In turn avoidable costs can be worked into risk adjustment and Pay for Performance.
