The ACG® System assists in evaluating disease management program effectiveness because it helps control varying levels of co-morbidity among enrolled patients. The ACG System also provides a highly robust disease classification system, EDCs™, that rolls the many unique diagnostic codes into 224 clinical groupings that are more amenable to action. Finally ACGs provide important contextual markers for assessing disease management effectiveness related to coordination of care and medication adherence.
In the population represented in Figure 1, the health plan has a goal to enroll 2000 members in their asthma disease management program each year. One of the key indicators for the population is an improvement in the rate of members dispensed a preferred asthma therapy (a higher overall rate is the desired result.)
Over time, the dispensing rate for these therapies is decreasing and is leading management to the conclusion that the disease management program is not achieving results. However, the picture is much different if you look at the results by co-morbidity level. Suppose the health plan has changed the criteria for acceptance into the asthma disease management program so that highly co-morbid members are excluded. These are patients with 6 or more chronic conditions, on average.
When you break the results by comorbidity level as in Figure 2, you see that there were modest improvements in each category except in the very high morbidity group where there were no members enrolled in year 2. Overall, compliance increases with increasing co-morbidity as these members are having more encounters and suffering greater symptoms. The opportunity for more proactive management is within the lower morbidity categories. Case-mix control using the ACG System is a critical component of evaluating program effectiveness and ROI.