The Diagnostic Cost Group Hierarchical Condition Category (DCG/HCC) payment models summarize the health care problems and predict the future health care costs of populations. These models use the diagnoses generated during patient encounters with the medical delivery system to infer which medical problems are present. Patient demographics and diagnostic profiles are, in turn, used to predict costs. We describe the logic, structure, coefficients and performance of DCG/HCC models, as developed and validated on three important data bases (privately insured, Medicaid, and Medicare) with more than 1 million people each
Using diagnoses to describe populations and predict costs
Ash, AS., Ellis, RP., Pope, G., Ayanian, JZ., Bates, DW., Burstin, H., Iezzoni, LI., MacKay, E., & Yu, W. (2000). Using diagnoses to describe populations and predict costs. Health Care Financing Review, 21(3), 7-28. http://www.cms.hhs.gov/HealthCareFinancingReview/Downloads/00springpg7.pdf
Abstract
Publications Info
To contact an RTI author, request a report, or for additional information about publications by our experts, send us your request.
Meet the Experts
View All ExpertsRecent Publications
Article
The daily association between affect and alcohol use: A meta-analysis of individual participant data
Article
Protection of forest ecosystems in the eastern United States from elevated atmospheric deposition of sulfur and nitrogen
Article
The use of patient experience feedback in rehabilitation quality improvement and codesign activities
Article