NACH develops a new system for risk-adjusting payments
Back Page Briefs
June 30, 1997
WASHINGTON, DC—The National Association of Children’s Hospitals (NACH) is putting the finishing touches on a new classification system that can be used to risk-adjust payment rates and to track the prevalence and cost of congenital and chronic illness among children and adults. The system uses ICD-9-CM diagnosis codes to identify individuals with a congenital or chronic health condition expected to last 12 months or longer. It also classifies them by some 250 condition categories, by body system, by severity level, and by disease progression.
NACH officials emphasized that their system will have application beyond risk adjustment, which is the primary goal of many such systems. The NACH system can be used to measure patient satisfaction in addition to tracking chronic disease prevalence rates and utilization and costs.
So far, the NACH system has been tested on full-service Medicaid claims data from Washington state. Initial results showed that costs for children with chronic conditions varied greatly from one severity level to another, sometimes doubling or tripling if the patient had multiple conditions involving different body systems. NACH Vice President John Muldoon says that the new system is different from other diagnostic-based classification schemes in the broadness of its application and the intensive "clinical workup" that occurs when a patient is classified under the NACH system.
Contact Mr. Muldoon at 703-684-1355
Mass. Atty. General distributes consumer guide on insurance reforms
BOSTON—To inform Massachusetts consumers about recent insurance reforms at the federal and state levels, the Attorney General’s Office has developed a brief consumer guide called "Your New Health Insurance Rights! A Guide To New Laws That Improve Your Access to Health Insurance Coverage." In addition to explaining basic protections under the Kassebaum-Kennedy law, the brochure states in simple language residents’ rights under recent reforms in the individual market in the state.
The guide explains continuation of coverage in cases of job loss or divorce under COBRA. Under a state law, divorced spouses are entitled to continue coverage indefinitely under the insured partner’s plan until they remarry, said Joanna Connolly, assistant attorney general. The guide is being distributed through hospitals that request it and the attorney general also is working with the state medical society to distribute it through doctors. Contact Ms. Connolly at 617-727-2200.
NACH develops a new system for risk-adjusting payments
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content
