What is DxCG intelligence?
DxCG Intelligence uses Cotiviti's proprietary predictive models to turn healthcare data into risk scores for individual members. Aggregating the scores of individuals with key attributes generates group-level predictive results that can help answer critical questions about healthcare efficiency. Click to see full answer.
What is the value of DCG risk adjustment?
The Value of the DCG Risk Adjustment Method Risk-adjust population-based benchmarks -enables a fair evaluation of providers and/or health plans adjusting for differences in underlying risk.
What is the range of the risk score?
Risk score is in the range between 0 and 100, and asset criticality, exposure value, and likelihood are all ranged between 0 and 10.
Are risk score values associated with diagnostic and demographic profiles overestimated?
Since a single risk score value is associated with that diagnostic and demographic profile, the individuals who share that profile but have higher costs will be underestimated while the individuals with that profile but lower costs will be overestimated. 47 © 2016 Society of Actuaries
What is DxCG intelligence?
DxCG Intelligence incorporates the industry's broadest set of risk management and predictive models, which in turn put the power of science to work in addressing your most pressing clinical and financial performance challenges.
What is risk score in health insurance?
In the health care industry, a risk score is a number that is assigned to patients based on their demographics and diagnoses—a numerical representation of how costly they are expected to be compared to the average patient. One of the common applications of using risk scores is to adjust premium payments.
What is a risk adjustment score?
Risk adjustment is a methodology that equates the health status of a person to a number, called a risk score, to predict healthcare costs. The “risk” to a health plan insuring members with expected high healthcare use is “adjusted” by also insuring members with anticipated lower healthcare costs.
What is a prospective risk score?
A prospective risk scoring model is then used to measure expected costs for both groups and the actual costs measured to determine the effect of the intervention. Choosing whether to use a concurrent or prospective risk scoring model in a health insurance system depends on the nature of the risk transfer in the system.
What is a high risk score?
High risk – a score over 15% means you are at high risk. If you have a score over 15%, you have at least a 1 in 7 chance of having a heart attack or stroke in the next five years, if nothing is changed.
How is risk score calculated?
The risk score is the result of your analysis, calculated by multiplying the Risk Impact Rating by Risk Probability.
What is a good Medicare risk score?
The CMS-HCC risk score for a beneficiary is the sum of the score or weight attributed to each of the demographic factors and HCCs within the model. The CMS-HCC model is normalized to 1.0. Beneficiaries would be considered relatively healthy, and therefore less costly, with a risk score less than 1.0.
What's a good RAF score?
A RAF score of 1.00 indicates the patient is expected to use an average amount of resources. A score above 1.00 indicates high risk and therefore the patient is expected to use more than the average amount of resources.
What does HCC mean in coding?
Hierarchical Condition CategoryRisk Adjustment and Hierarchical Condition Category (HCC) coding is a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997.
What is a good Mara risk score?
For example, Conifer and Milliman Advanced Risk Adjuster (MARA) are two popular models used by payers to produce static scores. A patient with a Conifer risk score greater than 30 is considered high-risk, as is a patient with a MARA risk score greater than 3.5.
What is DXCG intelligence?
DxCG Intelligence fully addresses cost, utilization, and risk across all populations. Our transparent, credible measures of population health risk are both clinically and financially grounded, increasing buy-in and making it easier for physicians, medical professionals, and analysts to see the impact of comorbidities, among other benefits.
What is the DXCG model?
Centers for Medicare & Medicaid Services (CMS) and served as the foundation for the Hierarchical Condition Category ( HCC) model that CMS still uses as the foundation for risk-adjusted healthcare payments today.
How many organizations use DXCG intelligence?
Nearly 500 organizations use DxCG Intelligence, which provides a common language of risk adjustment for healthcare payers and providers, for employers, for government agencies, and for academic researchers investigating ways to improve healthcare administration and delivery.
Why is risk adjustment important in healthcare?
Risk adjustment is a statistical process that allows organizations to make fair comparisons of healthcare delivery and payment systems, and in so doing, identify opportunities for improvement.
Is DXCG easy to implement?
DxCG Intelligence is easy to implement, whether an organization selects hosted or installed versions of the software, and integrates seamlessly with other software solutions. Our world-class customer support team supplies data acquisition and mapping support, software maintenance, educational resources, and access to our seasoned data scientists, statisticians, clinicians, and other subject-matter experts.
What is DXCG intelligence?
Using predictive models, DxCG Intelligence turns healthcare data into risk scores for individual patients. Scores correlate with the cost of the underlying illness burden that individuals carry. Aggregating the scores of individuals with key attributes generates group-level predictive results that can be applied to answer questions fundamental to the ability to manage clinical and financial risks.
How many models are there in DXCG?
Consisting of more than 100 models, DxCG Intelligence includes both concurrent and prospective variants. Models are grouped into three primary functional bundles—budgeting and underwriting, medical management, and performance assessment—that can be tailored for commercial, Medicare, and Medicaid populations.
What is ACG system?
The ACG System concurrent and prospective cost models measure the morbidity burden of patient populations based on disease patterns derived from the diagnostic and/or pharmaceutical code information found in insurance claims or other electronic medical records. A distinguishing feature of the ACG System is its "person-focused" approach emphasizing the constellation of morbidities rather than individual disease categories or stages allowing the System to capture the multidimensional nature of an individual's health over time. The program offers a suite of risk models (e.g likelihood of hospitalization, unexpected high pharmacy use, continuous high utilizer) as well as a range of clinical markers (e.g. to coordination of care, active treatment for specific disease categories, frailty …) that provide additional context to the interpretation of generated risk scores. 3.1.2 Chronic Illness & Disability Payment System and MedicaidRx (Vendor: University of California at San Diego)
What is a CRG classification?
CRGs are a classification system for describing the health status and burden of illness of individuals in an identified population. CRG relates the historical clinical and demographic characteristics of the enrollee (claim based diagnosis, procedure, pharmaceutical, and functional health status) to the amount and type of healthcare resource that enrollee will consume in the future. In addition, CRGs can be linked to critical outcomes such as rates of potentially Preventable Readmissions and Emergency Department Visits. The CRG system is a categorical clinical model that classifies each member of the population based on his or her burden of chronic medical conditions, assigning each individual into one of over 1,400 mutually exclusive risk categories. Individuals without a chronic condition are assigned to groups for healthy or significant acute illness. CRGs offer the user the choice of two models for both prospective and concurrent applications. The prospective model has 346 base categories and a total of 1,434 risk groups with severity level breakouts. These are also aggregated to three tiers with 618, 206, and 44 risk groups in each tier, respectively. The concurrent model is similar but with slightly more risk groups.
When was the CRG version 2.0 released?
For this study, a pre-release working version of the V2.0 CRG software from August 2015 was used. The fully updated V2.0 CRG software released by 3M in May 2016 contained additional updates to its categories and logic, but was not available in time to be used for this study.
What is risk scoring?
Risk scoring is the first step of that process – the means by which each individual is assigned a specific risk score. The second step of risk adjustment, the payment transfer, is not within the scope of this study, as it is typically not coupled with a particular model.
Why exclude CMS HCC model?
We excluded the Medicare Advantage CMS-HCC model, because it is specifically tailored for a Medicare population and would not be appropriate to compare along side the models focused on commercial-aged populations, particularly given the inclusion of the HHS-HCC model now used in the commercial sector.
