Risk adjustment for Medicare beneficiaries with Alzheimer's disease and related dementias.

Lin PJ, Maciejewski ML, Paul JE, Biddle AK. Risk adjustment for Medicare beneficiaries with Alzheimer's disease and related dementias. The American journal of managed care. 2010 Mar 1; 16(3):191-8.

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVE: To compare prospective risk adjustment measures on their ability to predict expenditures for Medicare beneficiaries with Alzheimer''s disease and related dementias (ADRD). METHODS: Data were obtained from the 1999-2004 Medicare Current Beneficiary Survey linked with Medicare claims. Beneficiaries'' base-year demographic and health characteristics were used to construct risk adjustment measures, comorbidity measures, functional status measures, and prior expenditures that were used to predict the subsequent year''s total and drug expenditures. Adjusted R(2) values, predictive ratios, and receiver operating characteristic curves were used to compare overall predictive power, accuracy of subgroup prediction, and accuracy in identifying beneficiaries with the top 10% of expenditures, respectively. RESULTS: The Centers for Medicare and Medicaid Services-Hierarchical Condition Category (CMS-HCC) and the Chronic Illness and Disability Payment System-Medicare had higher overall and subgroup predictive power for total expenditures compared with other diagnosis-based measures. The Prescription Drug Hierarchical Condition Category (RxHCC) exhibited greater predictive power for drug expenditures than other measures and outperformed other measures in identifying ADRD beneficiaries with extremely high drug expenditures. Adding functional status to single-measure models generally improved predictive power (ie, R(2) value) for overall health expenditures by 2% to 4%, but not for drug expenditures. CONCLUSIONS: The CMS-HCC and the RxHCC measures currently used by CMS are more predictive and accurate than other risk adjustment measures for overall and drug expenditure prediction for beneficiaries with substantial disabilities and comorbidities. Prediction of overall expenditures may be modestly improved for these beneficiaries by using a combined model of these measures and functional status.