Table 1.

Definition of Population Segmentation Based on Level of Care Need

Criteria	Relatively healthy	Simple chronic	Minor complex chronic	Major complex chronic	Frail	Non-elderly disabled
Care need	Low	Low	High	High	High	High
Age	Age ≥ 65	Age ≥ 65	Age ≥ 65	Age ≥ 65	Age ≥ 65	Age < 65
Health conditions	Without any chronic conditions (including non-complex and complex chronic conditions) and no limited activities of daily living	With 1–5 non-complex chronic conditions, but without any complex chronic conditions	With 1–2 complex chronic conditions and less than 6 non-complex chronic conditions	With 3 or more complex chronic conditions or at least 6 non-complex chronic conditions	With 2 or more conditions based on a modified list of the following 12 specific claims-based diagnoses potentially indicative of frailty (gait abnormality, malnutrition, failure to thrive, cachexia, debility, difficulty walking, history of fall, muscle wasting, muscle weakness, decubitus ulcer, senility, or durable medical equipment use)	Disabled or end-stage renal disease determined by the Social Security Administration