Predicting next year's healthcare costs is a very complicated process, and different vendors offer different methods. Some use certain Aritificial Intelligence algorithms, others use certain statistical formulas, but both of these are based on raw numbers and not the treatment logic--the real intelligence--behind the care.
SmartCare® incorporates what is perhaps the only predictive modeling engine available that is a true expert system. As presented more fully below, 3M's Clinical Risk Groups (CRG) software is built atop a knowledge base based on input from top physicians in many disciplines, which is updated every year. As diagnostic, place of service, specialty, lab, treatment, and even drug data is fed into it, the CRGs uncover relationships and fire rules written by these experts to create a more meaningful assessment. Then the assessment and classification are fed into its forecasting functions to generate a detailed analysis of probable costs in each CRG disease group category next year.
SmartCare® is available with 3M's CRG software for the finest predictive modeling available today.
Severity-Adjusted Disease Classification Models with 3M ’s CRG Software—and More
3M Health Information Systems spent 4 years developing its new CRG (Clinical Risk Groups) severity-adjusted patient population analysis engine. The intent was to create a true state-of-the-art risk adjustment system which would look at the entire medical history of a patient and determine the severity of their condition and how multiple chronic conditions overlap. Unlike other “risk groupers” on the market, the CRGs encompass the entire medical history rather than being limited to individual episodes. Also unlike other grouping software, it contains a clinical expert system rather than a purely mathematical algorithm for classifying episodes used by all other episode grouper software.
But episode-of-care grouping is still an important element of healthcare analysis, especially in a Managed Care environment. With SmartCare®’s own built-in episode-of-care grouper, you can see both the 3M CRG disease classifications and each patient’s unique episodes. Other “grouper” products may generate claims-based episodes, but not provide the overall health status or risk group, so you don’t have a context for the episodes. They can’t explain differences in practice patterns. There is no other tool in healthcare that gives you both except SmartCare® with the 3M CRGs.