Predicting costs of care using a pharmacy-based measure risk adjustment in a veteran population

Medical Care

Volumn 41, Issue 6, 2003, Pages 753-760

  Sales, Anne E ^a,b   Liu, Chuan Fen ^a,b   Sloan, Kevin L ^a,b   Malkin, Jesse ^c   Fishman, Paul A ^b,d   Rosen, Amy K ^e,f   Loveland, Susan ^e   Nichol, W Paul ^a,b   Suzuki, Norman T ^a,b   Perrin, Edward ^a   Sharp, Nancy D ^a,b   Todd Stenberg, Jeffrey ^a  

^a VA PUGET SOUND HEALTH CARE SYSTEM   (United States)

^b UNIVERSITY OF WASHINGTON   (United States)

^c RAND CORPORATION   (United States)

^d CENTER FOR HEALTH STUDIES   (United States)

^e VETERANS AFFAIRS MEDICAL CENTER   (United States)

^f BOSTON UNIVERSITY   (United States)

Author keywords

Case mix; Pharmacy; Risk adjustment; Veterans

Indexed keywords

ADOLESCENT; ADULT; AGE DISTRIBUTION; AGED; ARTICLE; COMPARATIVE STUDY; DIAGNOSIS RELATED GROUP; DRUG USE; ECONOMICS; EVALUATION; FEMALE; FORECASTING; GOVERNMENT; HEALTH CARE COST; HUMAN; MALE; MEDICAL INFORMATION SYSTEM; METHODOLOGY; MIDDLE AGED; PHARMACY; PRESCRIPTION; RISK ASSESSMENT; STATISTICAL MODEL; STATISTICS; UNITED STATES; VETERAN;

ADOLESCENT; ADULT; AGE DISTRIBUTION; AGED; CLINICAL PHARMACY INFORMATION SYSTEMS; DIAGNOSIS-RELATED GROUPS; DRUG UTILIZATION REVIEW; FEMALE; FORECASTING; HEALTH CARE COSTS; HUMANS; MALE; MIDDLE AGED; MODELS, ECONOMETRIC; NORTHWESTERN UNITED STATES; PHARMACIES; PRESCRIPTIONS, DRUG; RISK ADJUSTMENT; UNITED STATES; UNITED STATES DEPARTMENT OF VETERANS AFFAIRS; VETERANS;

EID: 85047697210     PISSN: 00257079     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.MLR.0000069502.75914.DD     Document Type: Article

References (24)

1. Roblin DW. Patient case mix measurement using outpatient drug dispense data. Managed Care Quarterly 1994;2:38-47.
2. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992;45:197-203.
3. Johnson RE, Hombrook MC, Nichols GA. Replicating the chronic disease score (CDS) from automated pharmacy data. J Clin Epidemiol 1994;47:1191-1199.
4. Clark DO, Von Korff M, Saunders K, et al. A chronic disease score with empirically derived weights. Mod Care 1995;33:783-795.
5. Roblin DW. Physician profiling using outpatient pharmacy data as a source for case mix measurement and risk adjustment. J Ambul Care Manage 1998;21:68-84.
6. Fishman PA, Goodman M, Hornbrook M, et al. Risk adjustment using automated pharmacy data: the R×Risk model. Med Care 2002;41:84-89.
7. Sloan KL, Sales AE, Liu CF, et al. Construction and characteristics of the RxRisk-V: a VA-adapted pharmacy-based case-mix instrument. Med Care 2003; 41:761-774.
8. Newhouse JP. Risk adjustment: where are we now? Inquiry 1998;35:122-131.
9. Weiner JP, Dobson A, Maxwell SL, et al. Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ Rev 1996;17:77-99.
10. Ash A, Porell F, Gruenberg L, et al. Adjusting Medicare capitation payments using prior hospitalization data. Health Care Financing Review 1989;10:17-29.
11. Ash AS, Ellis RP, Pope GC, et al. Using diagnoses to describe populations and predict costs. Health Care Financ Rev 2000;21:7-28.
12. Salem-Schatz S, Moore G, Rucker M, et al. The case for case-mix adjustment in practice profiling. When good apples look bad. JAMA 1994;272:871-874.
13. Parente ST, Weiner JP, Garnick DW, et al. Profiling resource use by primary-care practices: managed Medicare implications. Health Care Financ Rev 1996;17:23-42.
14. Rosen AK, Loveland S, Anderson JJ, et al. Evaluating diagnosis-based case-mix measures: how well do they apply to the VA population? Med Care 2001;39:692-704.
15. Pietz K, Byrne M, Petersen N. Results of Profiling Methodology Working Group. Presentation at VISN 20 CHIPS Annual Retreat, Seattle, WA, June 2000:14.
16. Weiner JP, Starfield BH, Steinwachs DM, et al. Development and application of a population-oriented measure of ambulatory care case-mix. Med Care 1991;29:452-472.
17. Weiner JP, Starfield BH, Lieberman RN. Johns Hopkins Ambulatory Care Groups (ACGs). A Case-mix system for UR, QA and capitation adjustment. HMD Pract 1992;6:13-19.
18. Ellis RP, Ash A. Refinements to the Diagnostic Cost Group (DCG) model. Inquiry 1995;32:418-429.
19. Pope GC, Ellis RC, Ash AS, et al. The principal inpatient Diagnostic Cost Group Model for Medicare risk adjustment. Health Care Financ Rev 2000;21:93-118.
20. Ellis RP, Pope GC, Iezzoni L, et al. Diagnosis-based risk adjustment for Medicare capitation payments. Health Care Financ Rev 1996;17:101-128.
21. Barnett PC, Rodgers JH. Use of the decision support system for VA cost-effectiveness research. Washington, DC: MDRC Working Meeting on Cost Studies; 1998.
22. Ashby J. The accuracy of cost measures derived from Medicare cost report data. Intramural Report I-93-01. Washington, DC: Prospective Payment Assessment Commission; 1993.
23. Shwartz M, Young DW, Siegrist R. The ratio of costs to charges: how good a basis for estimating costs? Inquiry 1995;32:476-481.
24. Department of Veterans Affairs, Veterans Health Administration. Health Economics Research Center. Available at: http://www.herc.research.med.va. gov. Accessed December 21, 2001.