ACG® System: DATA ANALYTICS

• No other risk-adjustment methodology has been used for so many purposes in so many places, while at the same time demonstrating such high levels of quantitative and qualitative success.
• For more than three decades, the ACG System has been the standard for risk adjustment. Based on the premise that clustering of morbidity is a better predictor of health services resource use than the presence of specific diseases or disease hierarchies, the ACG System provides a multi-morbidity framework that is clinically logical, informative about future healthcare resources, easy to use, and applicable to both financial and clinical managers.
• The ACG System is currently licensed and used in close to 30 countries worldwide. Billions of dollars per year are now routinely exchanged using the ACG System, while the practices of hundreds of thousands of physicians in many nations are now more equitably assessed and the health care of close to 200 million patients is actively managed and monitored using the ACG System. The system has broad applicability within the government and private sectors of many healthcare delivery systems, making the Johns Hopkins ACG System the most widely used population-based case-mix system in the world.
• The ACG System development team has been performing risk measurement and categorization research for more 30 years under the auspices of The Johns Hopkins University, a world-renowned academic research institution. The Johns Hopkins University’s Bloomberg School of Public Health has an unwavering commitment to the ongoing development of the ACG System and to its dissemination to both private sector and government users.

The ACG System measures the morbidity burden of patient populations based on disease patterns, age and gender. It relies on the diagnostic and/or pharmaceutical code information found in insurance claims or other electronic medical records. This provides the user with a more accurate representation of the morbidity burden of populations, subgroups or individual patients—as a constellation of morbidities, not as individual diseases.

The Johns Hopkins ACG System offers multiple perspectives for characterizing and assessing variations in morbidity burden across two or more patient populations. A key strength of the ACG System rests in its ability to capture the inter-relationships between co-occurring morbidities that are the hallmark of the very chronically ill populations that pose the greatest demands for health care resources. The clinical and statistical algorithms by which the tens of billions of potential disease combinations are distilled down to a fixed number of health status categories which are the essence of the ACG System.

The ACG System has been used in commercial and research settings worldwide, and used longer and more extensively than any other such system on the market today. It is a tried and true software product which has undergone numerous improvements and modifications in response to user needs.

What makes this Solution desirable?
The distinguishing feature of the ACG System is its “person-focused” approach, which allows it to capture the multidimensional nature of an individual’s health over time. Also, the ACG System is able to handle, describe and manage healthier populations (i.e., low users of healthcare services). Unlike other similar systems, the ACG system was developed using commercial managed care populations as well as state Medicaid populations, both of which closely resemble the general population. And the Johns Hopkins ACG System—which has been updated to reflect user suggestions and to respond to user needs—has been used in commercial and research settings worldwide, longer and more extensively than any other system currently available.

Among its unique strengths are

• its focus on categorizing people, not diagnosis codes;
• its ability to support the full spectrum of management applications;
• its refusal to base complexity on specific procedures or hospitalizations;
• its capacity to provide more than a simple score;
• its foundation built upon a well-defined set of clinical indicators that have been vetted in the health services research literature;
• its maximal use of available data selected from a suite of predictive models;
• its flexibility and ability to be customized.

How was this Solution developed?
The Johns Hopkins ACG System grew out of clinical observations made by Barbara Starfield, MD, MPH, in pediatric populations about 30 years ago. Research by Dr. Starfield and her colleagues in the early 1980s showed that children using the most health care resources were not those with a single chronic illness, but rather children with multiple, seemingly unrelated, conditions. Dr. Starfield was able to extend these findings to all patients and ultimately demonstrate that the clustering of morbidity is a better predictor of health services resource use than the presence of any specific diseases. Clustering of morbidity thus forms the basis of the ACG System and remains the fundamental concept that differentiates the ACG System from other case-mix adjustment methodologies.

The ACG System team—characterized by excellence in both research and practice–has virtually “written the book” on risk adjustment through numerous contributions in the published literature.

Which Benchmark/Pertinent Metrics are recommended to use with this Solution?

The Johns Hopkins ACG System offers multiple perspectives for characterizing and assessing variations in morbidity burden across two or more patient populations. A key strength of the ACG® System rests in its ability to capture the inter-relationships between co-occurring morbidities that are the hallmark of chronically ill populations that pose the greatest demands for health care resources. The clinical and statistical algorithms by which the tens of billions of potential disease combinations are distilled down to a fixed number of health status categories which are the essence of the ACG System. By using the System, an organization can harness the power of the ambulatory and inpatient diagnostic information as well as pharmaceutical information already captured within the organization’s databases.

Case-Mix Classification is a central feature of the ACG System, permitting comparisons between service populations that may differ significantly in terms of their overall health (morbidity burden). Comparative analyses have been used in a number of ways, including to fairly allocate health care resources, to assess provider performance, and to set insurance and reimbursement rates.[/toggle]

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The Johns Hopkins ACG® System State of the Art Technology and a Tradition of Excellence in One Integrated Solution

WONCA Conference Presentations

Study on Swedish Population Can gender difference in prescription drug use be explained by gender-related morbidity?