International

Despite vast differences in health care systems, there are common concerns around the world. As the Minister of Health of the Basque region pointed out in his opening address to our ACG Europe conference in 2004 in Bilbao,

"The development of new technologies and the computerization of the primary doctor’s office have altered radically the ability to apply patient classifications based on diagnosis. We observe how the social, demographic and morbidity aspects of our population change and as a consequence, how the health care system needs to change. With ACGs, we are able to add an information system tool to better adjust the limited resources to those clinics with the most need.”

The many tools of the ACG System have been applied in numerous countries around the world for a multitude of purposes, including, risk-adjusted provider payment, clinic profiling, high-risk patient identification, and academic research.

The ACG System has been designed to work with the available health care data and varying health care systems around the globe. The recent conversion of ACGs to accept ICD-10 was an important step in developing an internationally viable model easily adaptable to local situations. Recent studies have shown that the ICD-10 model performs accurately when using only ambulatory diagnoses, for predicting total as well as ambulatory costs. In addition, successful application of ACGs across countries, with varying health systems, has underscored ACGs validity.

In the past two years, ACG Europe has held user conferences in Berlin, Germany and in Bilbao, Spain. Two conferences, one in London, England, and the other in Barcelona, Spain are planned for May 2006.

Highlighted below are examples of how ACGs are being applied internationally.

Canada

British Columbia has been using the ACG System since 2000, primarily for practitioner profiling as part of a larger program of keeping the physicians accountable for fee for service. The ACG system is used to adjust for different expected amount of costs for physicians' medical care based on the burden of illness in the population they have in their patient panel.

Literature:

1. Reid, R. J., L. MacWilliam, et al. (2001). Performance of the ACG case-mix system in two Canadian provinces. Med Care 39(1): 86-99.
2. Reid, R. J., N. P. Roos, et al. (2002). Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba. Health Serv Res 37(5): 1345-64.

Nordic countries

The ACG system has been in use in Sweden for several years in numerous regions. Through academic research, pilot studies, on-going implementation in two regions, as well as a national evaluation, ACGs have demonstrated that they can be a useful tool for profiling and allocating resources in the Swedish primary health care system.

Continuing development work with our Nordic associate, Implementum Infromationskonsult AB, has improved the “Swedish relative weights” by using Swedish cost per patient data. A Swedish report generator, created by Datawell AB, presents the grouped outcome in a user-friendly manner capable of adjusting to the client’s needs and wishes. Nordic users have the opportunity to exchange their experiences with ACGs at the annual user conferences.

Spain

Over the last decade, several research institutes have been applying case-mix measures to the Primary Health Care (PHC) system in Spain. The research, which has focused on risk-adjusted resource allocation and budgeting, concluded that ACGs were the most suitable case-mix measure for primary health care in Spain.

Recent investments in information technology in PHC centers have made clinical data available from electronic patient records enabling implementation of ACGs in several regions on a pilot basis, assisted by our Spanish associates, Iasist.

The Basque Region is beginning its second year using ACGs to more equitable allocate resources amongst PHC centers. Catalonia is evaluating the performance of PHC providers controlling for morbidity with ACGs. In Aragon, ACGs have been used to adjust the pharmacy budget allocation.

The second Spanish ACG conference is scheduled for May 2006 in Barcelona.

Germany

Trends in health care reform in Germany demonstrate a continued interest in disease management programs, integrated care and gatekeeper models, indicating an on-going need for risk-adjustment with ACGs in the German health care system.

On-going projects are evaluating ACGs’ ability to assist sickness funds and provider networks in risk-adjusting capitated payments for integrated care networks. Hospitals are using ACGs to refine their DRG-based billing systems. Medical specialty associations are piloting ACGs to refine their payment structures and practice profiling. Finally, ACGs are being used in comparative treatment studies for pharmaceutical companies.

To support health care organizations in this changing health care market, ACGs’ new distributor, Gebera, GmbH, offers consulting and development services to better understand the impact of the morbidity of a population and how to best allocate limited resources. With the help of another German associate, Baumann [und] Nitscher Krankenhaus-Management GmbH, ACGs are being tailored to the German health care system.

Working with our research partner, Institut für Gesundheits- und Sozialforschung GmbH, our new pharmaceutical model will be further developed to include an International (ATC-based) version.

United Kingdom

ACGs have been used in academic research in England for several years, and recently, interest in risk adjustment models has been raised for application within the National Health Service. Possible applications include risk-adjusted provider commissioning, identification of patients for chronic care management programs, and provider profiling.

Working closely with the Imperial College London, Department of Primary Health Services Research, and the Tanaka Business School, Centre for Health Management, a pilot project has begun with several Strategic Health Authorities and Primary Care Trusts. The initial results are to be presented at a conference in May 2006 in London.

For more information:

IN SPAIN:

Sr. Antoni Arias Enrich
Director de Consultoria
Iasist
Rambla de Catalunya, 2-4, 60
08007 Barcelona
Spain
Fon...34-933-014-061
aarias@iasist.com

IN THE NORDIC COUNTRIES

Dr. Lars Lindö
CEO
Implementum Informationskonsult AB
Therese Svenssons gata 10
417 55 Göteborg
Sweden
Fon: ..46-31-933560
lars.lindo@implementum.se

IN THE REST OF EUROPE

Dr. Karen Kinder Siemens
Director ACG International Operations
The Johns Hopkins University