OBJECTIVE To examine and evaluate models that use inpatient encounter data and outpatient pharmacy claims data to predict future health care expenditures. DATA SOURCES/STUDY DESIGN The study group was the privately insured under-65 population in the 1997 and 1998 MEDSTAT Market Scan (R) Research Database. Pharmacy and disease profiles, created from… (More)
As health plans assume financial risk for providing health care services, effectively managing the health of a population remains one of the toughest challenges. This article shows how risk assessment methods can be used to measure disease burden in the full population and to discriminate levels of future health care needs within specific disease cohorts.… (More)
Gertzog for helpful discussion and comments on this paper.