In the shift from volume- to value-based care, one challenge is to measure patient health status and costs over time and across care settings. 3M Clinical Risk Groups (CRGs) measure illness and resource utilization of all patients, including children, low income or elderly individuals, commercial beneficiaries, and those with disabilities using inpatient, ambulatory, and pharmacy data.
Healthcare reform has spawned a range of initiatives to promote financial and clinical efficiency in healthcare delivery. Regardless of the payment model, one challenge is to measure patient health status and associated costs over time and across care settings. 3M Clinical Risk Groups (CRGs) provide a way to consider illness and resource utilization of a full range of patient types, including low income, elderly, commercial beneficiaries and those with disabilities. 3M CRGs use standard claims data and, when available, additional data—such as pharmaceutical data and functional health status—collected longitudinally to assign each individual to a single, mutually exclusive risk group. Each 3M CRG can be used to predict healthcare utilization and costs on a prospective as well as retrospective basis. 3M CRGs are similar in concept to Diagnosis Related Groups (DRGs), since they can be used to identify clinically meaningful groups of individuals who require similar amounts and types of resources. However, the DRG grouping process addresses a specific inpatient hospital admission, while the 3M CRG grouping process can analyze inpatient, ambulatory, and pharmacy data over a period of time. 3M CRGs are a powerful tool for targeting cases for care management, tracking patients over time, profiling providers, and enhancing the quality of the care delivered.