Case management decision support tools: predictive risk report or health risk assessment?

It is unclear whether health risk assessment (HRA) or claims-based risk modeling is a superior indicator of the need for case management in Medicaid adults with disabilities. This is a prospective cohort study designed to compare the use of a claims-based Predictive Risk Report (PRR) to a HRA in a Medicaid Supplemental Security Income managed care population. Both the claims-based risk scores and HRAs proved to be significant predictors of case management placement and subsequent emergency department and hospital utilization. The PRR-derived risk scores, however, could be obtained on virtually all enrollees at the time of enrollment, while HRA scores were obtained on only 54% of enrollees by 210 days of enrollment. Furthermore, case management reduced the risk of emergency and hospital utilization. We conclude that the PRR and HRA are equally reliable predictors of need for case management. The PRR has the advantage of earlier availability and of being easier to obtain.