AN OVERVIEW OF JOHN HOPKINS ACG-PREDICTIVE MODELING TOOL AND UNDERSTANDING RESOURCE UTILIZATION BANDS (RUBs)

INTRODUCTION The Adjusted Clinical Groups (ACG) is a population/patient case-mix adjustment system developed by researchers at The John Hopkins University School of Hygiene and Public Health in Baltimore, Maryland, USA. The ACG system measures health status by grouping diagnoses into clinically logical groups. The goal of the ACG system is to assign each individual a single, mutually exclusive ACG value, which is a relative measure of the individual’s expected or actual consumption of health services. The ACG system quantifies morbidity by grouping individuals based on their age and gender and all medical diagnoses that have been recorded over a defined period of time, typically one year. ICD-9 and ICD-10 codes typically come from administrative data sets (IEHP uses: outpatient claims, outpatient encounters, hospital claims).

Resource Utilization Bands (RUB) The ACG methodology places people into a discrete category based on their accumulated morbidity experience, their age and their sex. The result is that individuals within a given ACG have experienced a similar pattern of morbidity and resource consumption over the course of a given year. A patient is assigned to a single ACG based on the diagnoses assigned by all clinicians seeing them during all contacts, regardless of setting. Thus ACGs are truly person-oriented and are not based on visits or episodes. Resource Utilization Bands (RUBs) – represents a way of collapsing the multiple ACG categories into six resource groupings from very low (or non-users) to very high.

Resource Utilization Bands (RUB) Defined: RUB 0 (No Resource Use) RUB 1 (Low Expected Costs) RUB 2 (Low/Intermediate Expected Costs) RUB 3 (Intermediate Expected Costs) RUB 4 (Intermediate/High Expected Costs) RUB 5 + (High Expected Costs)

Use of the RUB Organizations can use the RUB to: Assess population risk and project future financial utilization Assess population for care management or disease management needs / interventions Example: Risk Adjustment Pyramid

An example of John Hopkins ACG- Predictive Modeling Metrics – View in MedHOK

An example of John Hopkins ACG- Predictive Modeling Metrics – Data File Date of last score calculation RUB Score

References: The John Hopkins ACG System, Technical User Guide Version 8.2, http://www.ensolution.se/upl/files/14428.pdf Concept: Adjusted Clinical Groups (ACG)-Overview, http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?printer=Y&conceptID=1304