In 2009, a sweeping reform implemented an overhaul of healthcare financing, and a morbidity-based risk adjustment of the transfer of funds within the German healthcare system. This process promoted the awareness of the case-mix to an audience of healthcare organizations, academic institutions, and government decision makers.
Subsequently, two German sickness funds, contractual partners of healthcare providers whose function amongst others is the reimbursement of healthcare providers, licensed the ACG® System to aid with the management of their members. The sickness funds use the ACG System primarily for controlling specific activities in the area of data analysis, including population comparisons, cost projections, identification of potential high-cost members, and member cost controlling. Cost controlling is done by establishing profiles of member groups, tracking changes in costs over time, and controlling budgets. The sickness funds are also applying the ACG System in innovative uses such as the outpatient management of patients with psychosocial disease clusters in order to avoid expensive inpatient care. They are also exploring a similar approach for other conditions clusters such as diabetes and hypertension.
The cooperation between one of the sickness funds and the ACG International team has resulted in the creation of new code sets based on the German adaptation of ICD-10 codes, as well as two new Risk Assessment Variable Sets (RAVS) that are based on this sickness fund’s own data.
The ACG System has proven to offer a more comprehensive assessment of morbidity and resource use at the member level compared to the standard morbidity-based risk adjustment tool currently used in Germany.