Types of Clinical Case-Mix Measures
| Measure | Primary Purpose | Inputs | Outputs | Data Sources |
|---|---|---|---|---|
| ACGs: Adjusted Clinical Groups. DCGs: Diagnostic Cost Groups. CDPS: Chronic Illness and Disability Payment System. HMO: Health Maintenance Organization. NDC: National Drug Codes. SF-36: Short Form Health Survey. | ||||
| Diagnosis-based ACGs, DCGs, CDPS | Health-based payment; provider profiling; quality assessment; resource allocation; disease/case management | All diagnoses from 1 year of age; age; gender | Number of ambulatory visits per year; total expenditures | Medicare; Medicaid; commercial populations (HMO claims/encounter data) |
| Pharmacy-based RxRisk | Health-based payment; disease/case management | NDC codes; age; gender | Pharmacy costs; total costs; ambulatory visits | Commercial populations; Medicaid data |
| Patient self-reported SF-36 measures | Describe morbidity | Clinical data | Ambulatory visits; total expenditures; functional status | Surveys; medical records |