3M™ Clinical Risk Grouping Software
Control healthcare costs, deliver quality
Payment reform has spawned a range of initiatives to promote financial and clinical efficiency in healthcare delivery. Regardless of the payment model, one challenge is to preserve incentives to treat high-risk patients, not simply to cut services across the board.
How do you measure the burden of illness?
3M Clinical Risk Groups (CRGs) provide a way to consider illness and resource utilization of a full range of patient types, including low income, elderly, commercial beneficiaries and those with disabilities. 3M CRGs use standard claims data and, when available, additional data—such as pharmaceutical data and functional health status—collected longitudinally to assign each individual to a single, mutually exclusive risk group.
Each 3M CRG can be used to predict healthcare utilization and costs on a prospective as well as retrospective basis. 3M CRGs are similar in concept to Diagnosis Related Groups (DRGs), since they can be used to identify clinically meaningful groups of individuals who require similar amounts and types of resources. However, the DRG grouping process addresses a specific inpatient hospital admission, while the 3M CRG grouping process can analyze inpatient, ambulatory, and pharmacy data over a period of time.
3M CRGs are a powerful tool for targeting cases for care management, tracking patients over time, profiling providers, and enhancing the quality of the care delivered.
Features and benefits
Insurance companies, health plans and other payers can benefit from the methodology because 3M CRGs quantify the total resources used in relation to a specific individual in the future, or in the past, over an extended period of time, while DRGs quantify resources used during a specific hospitalization. 3M CRGs capture the resource utilization of all inpatient and ambulatory encounters over a period of time.
Minimize financial incentives for adverse patient selection
With the predictive capability of 3M CRG Software, payers can easily set rates that minimize inappropriate incentives, and, at the same time, reward hospitals, physicians, and other providers who clinically and financially manage high-risk patients effectively.
Support accountable care and value-based purchasing
The 3M CRGs are a clinically-based risk-adjustment model and create a language that links the clinical and financial aspects of care. This “language” is easily understood by clinicians and therefore actionable. Government payers, health plans, accountable care organizations (ACOs), and employers alike can readily understand the completeness and accuracy of the 3M CRG concept of a “product definition with a price.”
3M CRGs also provide a methodology to group patients for retrospective analysis such as benchmarking, rate setting, epidemiological analysis and population risk profiling, especially for chronic care where patients may have multiple hospital and doctor visits over a long span of time.