Johns Hopkins ACG System

Manage provider performance, identify high-risk cases and predict healthcare resource utilization

Johns Hopkins' Adjusted Clinical Groups (ACG) System is a scientifically proven software tool for provider profiling, predictive modeling, resource management, and reimbursement rate adjustment.The ACG System provides markers of individual patient risk for the evaluation and forecasting of healthcare utilization and costs.

A major component of the financial risk for managed care plans is how sick their enrollees really are. The illness burden of enrollees will impact the accuracy of provider reimbursements, premium setting, performance measurements, and resource allocation. Using an innovative and proven patient classification system developed by Johns Hopkins University and marketed exclusively by DST Health Solutions, health plans can get the management information they need to accurately evaluate and forecast healthcare utilization.

ACGs help you:

• Identify high-risk cases using predictive modeling
• Calculate more accurate premiums for small and medium groups
• Set more equitable capitation rates
• Increase physician acceptance of performance monitoring
• Improve the accuracy of your efficiency profiling
• Monitor healthcare access

Developed and refined over 15 years by leading healthcare researchers at The Johns Hopkins Bloomberg School of Public Health, the ACG Case-Mix System helps organizations measure and account for variations in risk, or "illness burden," among the populations enrolled with your providers. This type of adjustment is essential in implementing fair and equitable management and payment strategies. Providers often perceive that their patients are sicker. ACGs help organizations objectively evaluate their illness burden.

The most recent addition to the Johns Hopkins ACG System is a predictive modeling suite derived from retail pharmacy claims only.  This innovative new method has advantages over more traditional predictions based on age, gender and prior cost because pharmacy data is timelier, more complete, and communicates more clinical information.  In instances where pharmacy claims are the only information available, predictive modeling can be used by organizations to develop care management interventions more quickly, to underwrite new groups and to support risk analysis for Medicare PDPs.

Most widely used risk adjustment system in the world

Adopted by more than 200 healthcare organizations in the U.S. and abroad that case-mix adjust more than 25 million covered lives, the ACG System is by far the most widely used and tested population-based, risk-adjustment system in the world. Used by leading managed care, government, and research organizations, ACGs are rapidly becoming the industry standard for profiling the global resource use of contracting physicians and developing risk-adjusted capitation and other risk-sharing arrangements.

Johns Hopkins ACG Web site

For more about Johns Hopkins ACG System, contact inforequests@dsthealthsolutions.com.