Exact(1)
Prior expenditures are a more powerful tool than diagnosis-based risk adjusters in terms of correctly identifying more actual high expenditures users.
Similar(59)
Prior expenditures status could correctly identify more actual high-expenditure users than diagnosis-based or demographics models.
Overall, diagnosis-based models correctly identify a much higher number of high-expenditure users than the demographic model.
Without risk adjustment models, the best that health plans can do to identify potentially high-expenditure users is to rely on prior expenditures status.
The prior expenditures approach is a more powerful tool than diagnosis-based risk adjusters in terms of correctly identifying actual high-expenditure users.
The proportions of true high-expenditure users that could be identified by diagnosis-based models alone were much lower than that by prior expenditures status.
Since high-expenditure users identified by diagnosis-based models have more 'manageable' diseases that are targets of disease management programs, it is the preferred model to use.
For estimating the amount of energy expenditure, users should be aware of the limitations of the MWK and other uniaxial accelerometers.
Individuals with claims data containing diagnosis codes related to these five conditions were then used as input for diagnosis-based risk adjustment models to identify high-expenditure users.
Utilization review has also been implemented by the Bureau of National Health Insurance BNHIin in Taiwan, but it was done retrospectively; under such situation, high-expenditure users could only be identified after a large amount of expenditures had occurred, and only a certain proportion of this population would remain high-expenditure users in the following years.
In addition, prior expenditures were also strongly related to current expenditures (Pearson's correlation coefficient between 2002 and 2003 total expenditures: 0.64), and about 50% of high-expenditure users in 2002 remained so in 2003.
Write better and faster with AI suggestions while staying true to your unique style.
Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com