|
Dear __: I am working with 3M HIS, the same folks who developed DRGs and APG/APCs, promoting a major information technology breakthrough -- Clinical Risk Groups. Please let me explain why I am so excited to be working on this project. You may be aware of my long-standing interest in risk adjustment (case-mix, acuity, case complexity and the intensity of service, etc.) and that I have published about the importance of information in health care including a series on Report cards (See below). In fact, under "Guidelines" this web site demonstrates a working version of a simple and powerful medical management report and incentive program that was implemented with great buy in. That report card uses CRGs! It is a common view that managed care suffers from not knowing what works. Having been a medical director for 30 years, I admit to having contributed to the unnecessary and fruitless complexity of managed care, as we know it. Managed care has not lived up to our expectations for too long, however, I think I have alighted on a cure for its ills. While working for a small HMO, recently, I implemented a program using the aforementioned CRGs. We realigned the physician incentives, reduced the complexity of our medical management procedures, improved treatment compliance, the quality of medical care and the clinical outcomes all with this single information engine; We used it with the best of breed data mining tool-SmartCare. Health plans need to learn that while the longitudinal view provided by "episodes of care" software like ETGs, ACGs, and MEDSTAT are making a contribution, they are "black boxes," by and large. That is to say you cannot explain how they work to the doctors who are being reviewed by them. CRG use a categorical model and that means I can communicate what each of the clinical risk groups means to any doctor. The CRG was introduced at the end of 1999 after 4 years and over $4 million in research; it is a method that improves communication about what happens to patients over time for their Primary Chronic Disease(s). I have studied CRGs, applied it, and gotten doctors to trust its results. I have used it to reimburse physicians and have even built incentives off of it. In my opinion, this is the only clinically defensible grouper/risk-adjuster/longitudinal perspective of patient care that I would use. This is the information solution for Medical Management because it is statistically robust, clinically stable, and versatile. For example, it is valuable in actuarial and budget work, when building or modifying incentive programs, doing UM, CQI, case management, disease management, demand management, etc. Every one of these disparate "managed care" functions can be powered by this one information engine. To see more about CRGs, go to www.3M.com and search on CRGs, or go to the "Current Technology" page, here; click on the babe who will be revealed when you run the mouse over the pregnant lady. {By the way, that babe is Jacob, our first grandson). References: |