Evaluating the Role of Past Clinical Information on Risk Adjustment. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Lin, John K.; Hong, Juliette; Phibbs, Ciaran; Almenoff, Peter; Wagner, Todd
• Is Part Of: Medical care. Volume 58:Issue 2(2020)
• Publication Date: 2020-02
• Subjects: risk adjustment -- cost -- performance measurement -- health economics; Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000001236
• Languages: English
• ISSNs: 0025-7079

Abstract

Abstract : Objective: The objective of this study was to evaluate whether incorporating historical clinical information beyond 1 year improves risk adjustment. Data Sources: Administrative data from the Department of Veterans Affairs and Medicare (for veterans concurrently enrolled in Medicare) for fiscal years (FYs) 2011–2015. Study Design: We regressed total annual costs on Medicare hierarchical condition category indicators and risk scores for FY 2015 in both a concurrent and a prospective model using 5-fold cross-validation. Regressions were repeated incorporating clinical information from FY 2011 to 2015. Model fit was appraised using R 2 and mean squared predictive error (MSPE). Data Collection: All veterans affairs users (n=3, 254, 783) with diagnostic information FY 2011–2015. Principal Findings: In a concurrent model, adding additional years of historical clinical information (FY 2011–2014) did not result in substantive gains in fit ( R 2 from 0.671 to 0.673) or predictive capability (MSPE from 1956 to 1950). In a prospective model, adding additional years of historical clinical information also did not result in substantive gains in fit ( R 2 from 0.334 to 0.344) or predictive capability (MSPE from 3988 to 3940). Conclusion: Incorporating historical clinical information yielded no material gain in risk adjustment fit. Abstract : Supplemental Digital Content is available in the text.