Johns Hopkins ACG System

In 2006, the Ministry of Health Malaysia was looking for more effective approaches to resource allocation. They engaged John Hopkins University Consultants and ACG® International to apply the ACG® System to the data obtained from electronic clinical information systems in both government clinics and the private sector, to monitor and improve the quality and efficiency of primary health care delivery in Malaysia.

Since 2006, The ACG® International team has collaborated with Israel’s largest health fund, a non-for-profit government-mandated insurer and healthcare provider (of primary, secondary and tertiary care) which counts 3.8 million enrollees and holds 53% of the market share, to better understand its members’ needs and characteristics.

During 2009, numerous contract bids were successfully awarded which utilized the ACG® System. With the current coverage of over 10% of the English population, the ACG System is well on its way to becoming the preferred risk adjustment tool in the National Health Service (NHS). Current licenses focus on the provision of commissioning services within NHS Primary Care Trusts (PCTs), and follow the increased policy emphasis on risk stratification for the UK population.

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.

Together with our local collaborator, ACG® International has been working with several regional governments in Spain since 2005 to provide them with the tools necessary to assess their primary care provider’s performance in a fair and accurate manner. The ACG® System allowed primary care managers to compare performance results from one primary care setting to another, and use this information to determine where practice improvements were needed. The ACG System has already been adopted as the primary care case-mix tool by two regional governments, while several other regional authorities are currently piloting the system.

In Sweden, healthcare is primarily public and funded through state taxes, which are distributed to county councils, who then allocate resources to their counties’ primary care centers and hospitals. Historically, this allocation of funds has been based on DRG’s at the hospital level, and on age and gender adjustments at the primary care level. After Sweden passed the freedom of choice model, which allows patients to choose their primary care provider, a better risk adjusted resource allocation system was required.

At the beginning of the 21st century, the government of a western Canadian province started holding physicians accountable for their overall billing patterns, with the annual reporting of each physician’s practice profile. This allowed physicians to compare their practice patterns with others, but it also provided the government with a guide to detect outliers suspected of fraud and abuse. In addition, it raised the need to use risk adjustment tools to ensure that physicians were being evaluated fairly.