Identifying Potential Care Management Candidates: The Use of Diagnosis-Based Models to Predict 5-Year Health Care...

This article examined individual characteristics associated with having higher costs in a 5-year period to identify patients that may potentially benefit from case management.

Florida Medicaid claims data from 2005 to 2010 were used to examine the characteristics, diagnoses, and services (in 2005) associated with individual costs in 5 future years (2006-2010). The data were divided into estimation and prediction samples with regression models estimated using diagnoses and service use in 2005 to predict future costs. Predictive power was assessed by applying the model results to the prediction sample and comparing predicted costs to actual costs.

Demographics, service use, and diagnosis in 2005 were associated with costs in the following 5 years. Models were predictive of future costs with a significant relationship between the predicted costs and actual costs.

Diagnosis-based models in conjunction with prior costs can predict future costs. Individuals predicted to have higher costs may be candidates for case management to potentially avoid reduce costs.