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Case Selection for a Medicaid Chronic Care Management Program by ProQuest

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Medicaid agencies are beginning to turn to care management to reduce costs and improve health care quality. One challenge is selecting members at risk of costly, preventable service utilization. Using claims data from the State of Vermont, we compare the ability of three pre-existing health risk predictive models to predict the top 10 percent of members with chronic conditions: Chronic Illness and Disability Payment System (CDPS), Diagnostic Cost Groups (DCG), and Adjusted Clinical Groups Predictive Model(TM) (ACG-PM(TM)). We find that the ACG-PM(TM) model performs best. However, for predicting the very highest-cost members (e.g., the 99th percentile), the DCG model is preferred. [PUBLICATION ABSTRACT]

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									  Case Selection for a Medicaid Chronic Care Management 

                          Program

                       Sharada Weir, D.Phil., Gideon Aweh, M.S., and Robin E. Clark, Ph.D.



   Medicaid agencies are beginning to turn                        care management is another approach to
to care management to reduce costs and                            defending limited funds against increasing
improve health care quality. One challenge                        health care costs. The care management
is selecting members at risk of costly, pre­                      approach seeks to engage consumers in
ventable service utilizat
								
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