Predicting future healthcare costs: How well does risk-adjustment work?

Journal of Health, Organisation and Management

Volumn 20, Issue 2, 2006, Pages 150-162

  Cucciare, Michael A ^a   O'Donohue, William ^a  

^a UNIVERSITY OF NEVADA   (United States)

Author keywords

Cost analysis; Health services sector; Risk assessment

Indexed keywords

EID: 33744465774     PISSN: 14777266     EISSN: None     Source Type: Journal    
DOI: 10.1108/14777260610661547     Document Type: Article

References (26)

1. Armour, S. and Appleby, J. (2003), "As health care costs rise, workers shoulder burden", USA Today, available at: www.usatoday.com/news/ nation/2003-10-20-healthcare-cover_x.htm (accessed December 2, 2003).
2. Ash, A.S. and Byrne-Logan, S. (1998), "How well do models work? Predicting health care costs", Proceedings of the Section on Statistics in Epidemiology of the American Statistical Association, Dallas, TX.
3. Ash, A.S., Ellis, R., Pope, G.C., Ayanian, J.Z., Bates, D.W. and Burstin, H. et al., (2000), "Using diagnoses to describe populations and predict costs", Health Care Financing Review, Vol. 21 No. 3, pp. 7-28.
4. Ash, A.S., Zhao, Y., Ellis, R.P. and Kramer, M.S. (2001), "Finding future high-cost cases: comparing prior cost versus diagnosis-based methods", Health Services Research, Vol. 36 No. 6, pp. 194-206.
5. Axelrod, R.C. and Vogel, D. (2003), "Risk-adjustment modeling in health plans", Disease Management and Health Outcomes, Vol. 11 No. 12, pp. 779-87.
6. Berk, M.L. and Monheit, A.C. (2001), "The concentration of health care expenditures, revisited", Health Affairs, Vol. 20, pp. 9-18.
7. Berman, J. (2004), "DxCG's predictive modeling can project patient costs", Health-IT World, availabl at: www.health-itworld.com/enewsarchive/ e_article000176106.cfm (accessed November 15, 2004).
8. Carter, G.M., Bell, R.M., DuBois, R.W., Goldberg, G.A., Keeler, E.B. and McAlearney, J.S. et al., (2000), "A clinically detailed risk information system for cost", Health Care Financing Review, Vol. 21 No. 3, pp. 65-91.
9. Cucciare, M.A. and O'Donohue, W.T. (2003), "Integrated care and the high utilizer: an explication of medical usage patterns and the role in the healthcare crisis", in Cummings, N.A., O'Donohue, W.T. and Ferguson, K.E. (Eds), Behavioral Health as Primary Care: Beyond Efficacy to Effectiveness, Context Press, Reno, NV.
10. Cummings, N.A., Cummings, J.L. and Johnson, J.N. (Eds) (1997), Behavioral Health in Primary Care: A Guide for Clinical Integration, Psychosocial Press, Madison, CT.
11. Foxman, B. and Edington, D.W. (1987), "The accuracy of health risk appraisal in predicting mortality", American Journal of Public Health, Vol. 77 No. 8, pp. 971-4.
12. Friedman, R., Sobel, D., Myers, P., Caudill, M. and Benson, H. (1995), "Behavioral medicine, clinical health psychology, and cost offset", Health Psychology, Vol. 14, pp. 509-18.
13. Gazmararian, J.A., Foxman, B., Tze-Ching Yen, L., Morgenstern, H. and Edington, D.W. (1991), "Comparing the predictive accuracy of health risk appraisals: the centers for disease control versus carter center program", American Journal of Public Health, Vol. 8, pp. 1296-301.
14. Greenwald, L.M. (2000), "Medicare risk-adjusted capitation payments: from research to implementation", Health Care Financing Review, Vol. 21 No. 3, pp. 1-5.
15. Howell, D.C. (1995), Fundamental Statistics for the Behavioral Sciences, 3rd ed., Duxberry Press, Belmont, CA.
16. Kapur, K., Young, A.S. and Murata, D. (2000), "Risk adjustment for high utilizers of public mental health care", The Journal of Mental Health Policy and Economics, Vol. 3, pp. 129-37.
17. Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E. and Unutzer, J. et al., (1999), "Stepped collaborative care for primary care patients with persistent symptoms of depression", Archives of General Psychiatry, Vol. 56, pp. 1109-15.
18. Moon, J.R. (1997), "Partnerships with primary care physicians: reinventing gatekeeper relationships", in Cummings, N.A., Cummings, J.L. and Johnson, J.N. (Eds), Behavioral Health in Primary Care: A Guide for Clinical Integration, Psychosocial Press, Madison, CT, pp. 305-23.
19. O'Donohue, W.T. and Cucciare, M.A. (2005), "Pathways to medical service utilization", Journal of Clinical Psychology in Medical Settings, Vol. 12 No. 2, pp. 185-97.
20. Pope, G.C., Ellis, R.P., Ash, A.S., Liu, C.F., Ayanian, J.Z. and Bates, D.W. et al., (2000), "Principal inpatient diagnostic cost group model for medicare risk adjustment", Health Care Financing Review, Vol. 21 No. 3, pp. 93-118.
21. Riley, G.F. (2000), "Risk adjustment for health plans disproportionately enrolling frail medicare beneficiaries", Health Care Financing Review, Vol. 21 No. 3, pp. 135-48.
22. Smith, K.W., McKinlay, S.M. and McKinlay, J.B. (1991), "The validity of health risk appraisals for coronary heart disease: results from a randomized field trial", American Journal of Public Health, Vol. 81 No. 4, pp. 466-70.
23. Smith, K.W., McKinlay, S.M. and Thorington, B.D. (1987), "The validity of health risk appraisal instruments for assessing coronary heart disease risk", American Journal of Public Health, Vol. 77 No. 4, pp. 419-24.
24. Young, A.S., Sullivan, G., Burnham, M.A. and Brook, R.H. (1998), "Measuring the quality of outpatient treatment for schizophrenia", Archives of General Psychiatry, Vol. 55 No. 7, pp. 611-7.
25. Zhao, Y., Ash, A.S., Ellis, R.P. and Slaughter, J.P. (2002), "Disease burden profiles: an emerging tool for managing managed care", Health Care Management Science, Vol. 5, pp. 211-9.
26. Greenwald, L.M., Esposito, A., Ingber, M.J. and Levy, J.M. (1998), "Risk adjustment for the medicare program: lessons learned from research and demonstrations", Inquiry, Vol. 35 No. 2, pp. 193-209.