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Predicting High-risk and High-cost Patients for Proactive Intervention.

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A new predictive model accurately identifies high-risk, high-cost (HRHC) patients using administrative data and clinical classifications. This enables proactive interventions to improve healthcare outcomes and reduce costs.

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Area of Science:

  • Health Services Research
  • Health Informatics
  • Predictive Analytics

Background:

  • A small percentage of patients account for a disproportionately large share of healthcare expenditures.
  • Proactive intervention for high-risk, high-cost (HRHC) patients is a key strategy for cost reduction and improved health outcomes.
  • Accurate identification of HRHC patients is crucial for effective resource allocation and care management.

Purpose of the Study:

  • To develop and validate a predictive model for identifying HRHC patients with enhanced accuracy.
  • To assess the predictive power of various statistical models and comorbidity datasets for cost prediction.
  • To provide a tool for value-based health systems to proactively manage high-cost patient populations.

Main Methods:

  • Observational study utilizing administrative data from the Veterans Health Administration for fiscal years 2018 and 2019.
  • Analysis included over 5.6 million patients with continuous care across both fiscal years.
  • Split-sample validation was employed to evaluate 5 statistical models and 3 sets of patient comorbidities, including expanded Clinical Classifications Software Refined (CCSR) groups.

Main Results:

  • Box-Cox regression utilizing expanded CCSR groups as predictors demonstrated the highest predictive accuracy.
  • The model achieved an R-squared value of 0.51 for transformed cost and 0.37 for raw scale cost.
  • The developed model significantly outperformed previously reported predictive models in the literature.

Conclusions:

  • The study successfully developed a highly predictive model for identifying HRHC patients.
  • The algorithm leverages readily available administrative data and a public classification system (CCSR).
  • This model offers a practical and implementable solution for healthcare systems aiming for value-based care and proactive patient management.