Data Analytical Tools

Methodology

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.

  • CRGs recognize 269 separate primary chronic diseases, with 1,073 unique categories at the lowest tier of aggregation, and 37 at the highest

  • Case mix and Severity adjustment at every level, enables measurement and monitoring of disease burden and its progression

  • 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

 


CareAdvantage, Inc.     485C Rt. 1 South,    Iselin, NJ 08830     732.362.5000    (Fax) 732.362.5005

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