"Impactibility models": Identifying the subgroup of high-risk patients most amenable to hospital-avoidance programs

Milbank Quarterly

Volumn 88, Issue 2, 2010, Pages 240-255

  Lewis, Geraint H ^a  

^a Health Education England   (United Kingdom)

Author keywords

Access; Equity; Hospital avoidance; Impactibility; Predictive modeling

Indexed keywords

AMBULATORY CARE; ARTICLE; EVIDENCE BASED MEDICINE; HEALTH CARE COST; HEALTH CARE PERSONNEL; HEALTH PROGRAM; HIGH RISK PATIENT; HOSPITAL CARE; HOSPITALIZATION; HUMAN; MEDICAID; MEDICAL RESEARCH; MEDICARE; PRACTICE GUIDELINE; PREVENTIVE HEALTH SERVICE; PRIORITY JOURNAL; RISK ASSESSMENT; SEMI STRUCTURED INTERVIEW;

FORECASTING; HOSPITALIZATION; HUMANS; INTERVIEWS AS TOPIC; MODELS, THEORETICAL; PREVENTIVE HEALTH SERVICES; RISK ASSESSMENT; RISK FACTORS; UNITED STATES;

EID: 77953772801     PISSN: 0887378X     EISSN: 14680009     Source Type: Journal    
DOI: 10.1111/j.1468-0009.2010.00597.x     Document Type: Article

References (31)

1. Abelson, R. 2008. Medicare Finds How Hard It Is to Save Money. New York Times, April 7, 2008.
2. AcademyHealth. 2008. 2008 HSR Impact Awardee: Risk-Based Predictive Modeling - Improving the Financing and Delivery of Health Care with Risk-Based Predictive Modeling. Available at http://www.academyhealth.org/files/awards/ Risk-BasedPredictiveModeling.pdf (accessed March 10, 2010).
3. Billings, J., and T. Mijanovich. 2007. Improving the Management of Care for High-Cost Medicaid Patients. Health Affairs 26 (6 1643 1654.
4. Billings, J., and T. Mijanovich. 2008. Narrow Model: The Authors Respond. Health Affairs 27 (3 900.
5. Billings, J., T. Mijanovich, J. Dixon, N. Curry, D. Wennberg, B. Darin, and K. Steinort. 2006. Case Finding Algorithms for Patients at Risk of Re-Hospitalization, PARR 1 and PARR 2.
6. Billings, J., L. Zeitel, J. Lukomnik, T.S. Carey, A.E. Blank, and L. Newman. 1993. Impact of Socioeconomic Status on Hospital Use in New York City. Health Affairs 12 (1 162 173.
7. Centers for Medicare and Medicaid Services. 2008a. Medicare Coordinated Care Demonstration. Available at http://www.cms.hhs.gov/DemoProjectsEvalRpts/ downloads/CC-Fact-Sheet.pdf (accessed February 13, 2009).
8. Centers for Medicare and Medicaid Services. 2008b. Medicare Health Support, Overview. Available at http://www.cms.hhs.gov/CCIP/ (accessed February 8, 2009).
9. Cousins, M.S., L.M. Shickle, and J.A. Bander. 2002. An Introduction to Predictive Modeling for Disease Management Risk Stratification. Disease Management 5 (3 157 167.
10. Cucciare, M.A., and W. O'Donohue. 2006. Predicting Future Healthcare Costs: How Well Does Risk-Adjustment Work? Journal of Health Organization and Management 20 (2 150 162.
11. Cummings, N.A., J.L. Cummings, and L.N. Johnson, eds. 1997. Behavioral Health in Primary Care: A Guide for Clinical Integration.
12. Curry, N., J. Billings, B. Darin, J. Dixon, M. Williams, and D. Wennberg. 2005. Predictive Risk Project Literature Review.
13. Duncan, I., ed. 2004. Dictionary of Disease Management Terminology.
14. Ellis, R. 1998. Creaming, Skimping and Dumping: Provider Competition on the Intensive and Extensive Margins. Journal of Health Economics 17 (5 537 556.
15. Ellis, R., G. Pope, L. Iezzoni, J.Z. Ayanian, D.W. Bates, H. Burstin, and A.S. Ash. 1996. Diagnosis-Based Risk Adjustment for Medicare Capitation Payments. Health Care Financing Review 17 (3 101 128.
16. Hibbard, J.H., J. Stockard, R. Eldon, E.R. Mahoney, and M. Tusler. 2004. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research 39 (4, part 1 1005 1026.
17. Hu, G., and E. Lesneski. 2004. The Differences between Claim-Based Health Risk Adjustment Models and Cost Prediction Models. Disease Management 7 (2 153 158.
18. Krause, D.S. 2005. Economic Effectiveness of Disease Management Programs: A Meta-analysis. Disease Management 8 (2 114 134.
19. MacStravic, S. 2007. The Challenge of Participation in Disease Management. Disease Management 10 (5 247 251.
20. Majeed, A., A.B. Bindman, and J.P. Weiner. 2001. Use of Risk Adjustment in Setting Budgets and Measuring Performance in Primary Care I: How It Works. British Medical Journal 323 (7313 604 607.
21. Milliman Inc. 2009. Milliman Care Guidelines. Available at http://www.milliman.com/expertise/healthcare/products-tools/milliman-care- guidelines/ (accessed February 8, 2009).
22. New York State Department of Health. 2008a. Request for Proposals - Chronic Illness Demonstration Projects. Available at http://www.health.state.ny. us/funding/rfp/0801031003/ (accessed February 8, 2009).
23. New York State Department of Health. 2008b. Request for Proposals for Office of Health Insurance Programs. Available at http://www.health.state.ny.us/ funding/rfp/0801031003/0801031003.pdf (accessed May 15, 2009).
24. Peikes, D., A. Chen, J. Schore, and R. Brown. 2009. Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures among Medicare Beneficiaries: 15 Randomized Trials. Journal of the American Medical Association 301 (6 603 618.
25. Prochaska, J.O., and C.C. DiClemente. 1983. Stages and Processes of Self-Change of Smoking: Toward an Integrative Model of Change. Journal of Consulting and Clinical Psychology 51 (3 390 395.
26. Roland, M., M. Dusheiko, H. Gravelle, and S. Parker. 2005. Follow up of People Aged 65 and Over with a History of Emergency Admissions: Analysis of Routine Admissions Data. British Medical Journal 330 (7486 289 292.
27. Schwartz, D. 2007. Predictive Modeling in Disease Management. 2nd ed.
28. Sommers, A., and M. Cohen. 2006. Medicaid's High Cost Enrollees: How Much Do They Drive Program Spending?
29. Stehno, C.E. 2007. An Innovative Health Risk Measurement Technique for Disease Management. Disease Management 10 (1 1 5.
30. Weber, C., and K. Neeser. 2006. Using Individualized Predictive Disease Modeling to Identify Patients with the Potential to Benefit from a Disease Management Program for Diabetes Mellitus. Disease Management 9 (4 242 255.
31. Weiner, J.P., B.H. Starfield, D.M. Steinwachs, and L.M. Mumford. 1991. Development and Application of a Population-Oriented Measure of Ambulatory Care Case Mix. Medical Care 29 (5 453 472.