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The Foundation
One of RPNavigator's core foundation algorithms is 3M's Clinical
Risk Groups™ (CRGs). It is a categorical, clinical model, that
uses medical and pharmacy claims and other data to assign a member
to a single, mutually exclusive, risk category, which prevents
double counting of members. This algorithm, based on a
second-generation risk stratification methodology, is used to
analyze a health plan's entire member population, from a disease and
severity perspective. This open logic of CRGs was clinically
developed and is easily understood. 
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CRGs recognize 269 separate primary chronic diseases, with
1,073 unique categories at the lowest tier of aggregation, and
37 at the highest
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Case mix and Severity adjustment at every level, enables measurement and monitoring of disease burden and its progression
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CRGs determine the health status of a population from a
clinical and cost perspective
RPNavigator also includes the use of All
Patient Refined DRGs™ (APR-DRGs) to severity adjust hospital
admissions by length of stay and component costs, providing
comparisons to benchmarks using internal and/or state and national
norms. This technique also benchmarks ancillary charge components of
claims to uncover inefficiencies during hospital stays.
RPNavigator is a solution that is designed
and customized to meet our clients' specific management
requirements. It is a solution that provides a more comprehensive
approach to risk management. It is supported by our team of
experienced health plan executives, senior medical directors,
experienced care management operations directors, and clinical data
analysis subject matter experts, bolstered by our in-house
technology experts.
Request a white
paper on CRG'S and APR-CRG'S
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