Risk adjustment using automated ambulatory pharmacy data the RxRisk model

Medical Care

Volumn 41, Issue 1, 2003, Pages 84-99

  Fishman, Paul A ^a   Goodman, Michael J ^b   Hornbrook, Mark C ^c   Meenan, Richard T ^c   Bachman, Donald J ^c   O'Keeffe Rosetti, Maureen C ^c  

^a CENTER FOR HEALTH STUDIES   (United States)

^b HEALTHPARTNERS RESEARCH FOUNDATION   (United States)

^c CENTER FOR HEALTH RESEARCH   (United States)

Author keywords

Pharmacy; Risk adjustment; Risk assessment

Indexed keywords

ADOLESCENT; ADULT; AGE; AGED; ALGORITHM; ARTICLE; CHILD; CHRONIC DISEASE; CLASSIFICATION; COHORT ANALYSIS; COMPARATIVE STUDY; DRUG COST; ECONOMICS; FEMALE; FORECASTING; HEALTH CARE COST; HEALTH ECONOMICS; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MALE; MEDICAL INFORMATION SYSTEM; MIDDLE AGED; OUTPATIENT; PRESCHOOL CHILD; PRESCRIPTION; REGRESSION ANALYSIS; RETROSPECTIVE STUDY; RISK ASSESSMENT; SEX DIFFERENCE; STATISTICAL MODEL; UNITED STATES;

ADOLESCENT; ADULT; AGE FACTORS; AGED; ALGORITHMS; CHILD; CHILD, PRESCHOOL; CHRONIC DISEASE; CLINICAL PHARMACY INFORMATION SYSTEMS; COHORT STUDIES; DRUG COSTS; ECONOMICS, MEDICAL; FEMALE; FORECASTING; HEALTH CARE COSTS; HEALTH EXPENDITURES; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; MALE; MIDDLE AGED; MODELS, ECONOMETRIC; OUTPATIENTS; PRESCRIPTIONS, DRUG; REGRESSION ANALYSIS; RETROSPECTIVE STUDIES; RISK ADJUSTMENT; SEX FACTORS; UNITED STATES;

EID: 0037264203     PISSN: 00257079     EISSN: None     Source Type: Journal    
DOI: 10.1097/00005650-200301000-00011     Document Type: Article

References (29)

1. Ash A, Powell F, Gruenberg L, et al. Adjusting Medicare payments using prior hospitalization data. Health Care Financing Review 1989;10:17.
2. Starfield B, Weiner J, Mumford L, et al. Ambulatory Care Groups: A categorization of diagnoses for research and management. Health Serv Res 1991;26:53-74.
3. Weiner JP, Starfield BH, Steinwachs DM, et al. Development and application of a population-oriented measure of ambulatory case-mix. Med Care 1991;29:452-472.
4. Kronick R, Dreyfus T, Lee L, Zhou Z. Diagnostic risk adjustment for Medicaid: the disability payment system. Health Care Finan Rev 1996;17:7-33.
5. Kronick R, Gilmer T, Dreyfus T, Lee L. Improving health-based payment for Medicaid beneficiaries: The Chronic and Disability Payment System. Health Care Finan Rev 2000;21:29-64.
6. Hornbrook MC, Goodman MJ, Fishman PA, et al. Global risk-assessment models: demographic and diagnostic approaches. Presented at the Annual Meeting of the Association for Health Serv Res. Atlanta, GA, June 1996.
7. American Medical Association, ICD-9-CM. International Classification of Diseases, 9th Revision, Volumes 1 and 2. Chicago, IL: American Medical Association; 2002.
8. Clark DO, Von Korff M, Saunders K, et al. A chronic disease score with empirically derived weights. Med Care 1995;33:783-795.
9. Lamers LM. Pharmacy costs groups: a risk-adjuster for capitation payments based on the use of prescribed drugs. Med Care 1999;37:824-830.
10. Roblin DW. Physician profiling using outpatient pharmacy data as a source for case mix measurement and risk adjustment. J Ambul Care Manag 1998;21:68-84.
11. Fishman P, Shay D. Development and estimation of a pediatric chronic disease score from automated pharmacy data. Med Care 1999;37:872-880.
12. Gilmer T, Kronick R, Fishman P, et al. The Medicaid RX model: Pharmacy-based risk adjustment for public programs. Med Care 2001;39:1188-1202.
13. Fishman PA, Wagner EH. Managed care data and public health: The experience of Group Health Cooperative of Puget Sound Annual Review of Public Health 1998;19:477-491
14. Goodman M, Bachman D, Fishman P, et al. Variations in Diagnosis Coding Practices Across Multiple HMDs. Paper presented at the 16th Annual Association for Health Serv Res Annual Meetings Chicago, IL, June 1999:26.
15. Johnson RE, Hornbrook MC, Nichols GA. Replicating the Chronic Disease Score (CDS) from automated pharmacy data. J din Epidemiol 1994;47:1191-1199.
16. AHFS 2002. Drug Information. American Hospital Formulary Service, Bethesda, MD, 2001.
17. Hornbrook MC, Goodman MJ. Health Plan Case Mix: Definition, Measurement, And Use. In: Hornbrook MC, editor. Advances in Health Economics and Health Serv Res, Vol. 10 Greenwich, CT: JAI Press, 1989:41.
18. Duan N, Manning VV, Morris C, Newhouse J. A comparison of alternative models for the demand for medical care. J Bus Econ Stat 1983;1:115.
19. Duan N, Manning W, Morris C, Newhouse J. Choosing between the sample selection model and the multi-part model. J Bus Econ Stat 1984;2:283.
20. Duan N. Smearing estimate: A non-parametric retransformation method. J Am Stat Assoc 1983;78:605.
21. Blough DK, Madden CW, Hornbrook MC. Modeling risk using generalized linear models. J Health Econ 1999;18:153-171.
22. Fishman PA, Goodman MG, Hornbrook MC, et al. Selecting Functional Forms to Assure Appropriate Payment for Chronic Disease. Paper presented at 15th Annual Association for Health Serv Res Meeting, Atlanta, GA, June 1996:9.
23. Mincer J, Zarnowitz V. The evaluation of economic forecasts. Economic Forecasts and Expectations New York: National Bureau of Economic Research, 1969.
24. Pope GC, Ellis RP, Ash AS, et al. Principal inpatient diagnostic cost group model for Medicare risk adjustment. Health Care Finan Rev 2000;21:93-118.
25. Anderson GF, Bilenker JH. Capitation payment rates and implications for the general pediatrician. Curr Opin Pediatr 1998;10:480-485.
26. Boyle CA, Decoufle P, Yeargin-Allsop M. Prevalence and impact of developmental disabilities in US children. Pediatrics 1994;93:399-403.
27. Hobbs N, Perrin J, Ireys H. Chronically Ill Children and their Families. San Francisco, CA: Jossey-Bass; 1985.
28. Neff JM, Anderson G. Protecting children with chronic illness in a competitive marketplace. JAMA 1995;274:1866-1869.
29. Newhouse JP, Manning VVG, Keeler EB, et al. Adjusting capitation rates using objective health measures and prior utilization. Health Care Fmanc Rev 1989;10:41-54.