A key provision of the Patient Protection and Affordable Care Act (ACA) is the establishment of state-level HIEs to support the individual and small group health insurance markets. Effective mechanisms to account for differences in risk across enrollees choosing different health plans within the Exchange are essential and required by the legislation.
The “ACG-HIE” software is based on the highly respected Johns Hopkins ACG System that has been widely used around the world for more than two decades. Today, the ACG System helps to finance and manage the care of millions of individuals enrolled in numerous public and private health plans and programs in the US and in a dozen other nations. Johns Hopkins has made available a no cost "ACG-Medicaid" version to State Medicaid agencies for risk adjusted payment purposes since 2003. Sixteen Medicaid agencies currently use the ACG System.
The newly developed Johns Hopkins ACG-HIE version is state-of-the-art and has superior predictive accuracy (See Table 1). This software will offer the HIE maximum flexibility. States can get started on day-one with built-in "risk weights" embedded in the software.. The Johns Hopkins ACG software will allow the Exchange to calculate enrollee risk scores using either diagnosis (ICD) or pharmacy (NDC) data inputs.
The ACG-HIE software will compute predictive risk scores and provide a series of informative risk markers for each enrollee. These measures can be used to calibrate or customize the State's risk adjustment model to meet local needs. Using algorithms developed by Johns Hopkins public health and clinical faculty, for each enrollee the software will document medical need within many disease-specific categories and a series of unique risk level measures indicative of multi-morbidity and frailty/disability.
The future growth and stability of the ACG risk adjustment methodology is assured. The ACG System is the only such methodology supported by a full time university based team with an ongoing focus on research, development and system maintenance. This Johns Hopkins team is constantly working to incorporate the latest clinical and health services knowledge into the ACG System. The software is updated quarterly to incorporate all new diagnoses and pharmacy codes. And because of its widespread international use, the System is already ICD-10 compliant. In addition to the backing of a renowned research university, the ACG System is supported by its US distribution partner -- DST HealthSolutions, LLC; Together, they have been providing education and support to public and private ACG System users for 20 years including web based and on-site training and conferences.
With its extensive documentation and its large base of scientific research (over 200 articles) the Johns Hopkins ACG System is arguably the best documented, most transparent and extensively researched population-based risk adjustment method ever developed. A bibliography of research articles is available here.
Click here to read the JHU Gazette article on how the new ACG-HIE software will support health care reform.