Table 1:

Types of Clinical Case-Mix Measures

Measure	Primary Purpose	Inputs	Outputs	Data Sources
Diagnosis-based ACGs, DCGs, CDPS	Health-based payment; provider profiling; quality assessment; resource allocation; disease/case management	All diagnoses from 1 year of age; age; gender	Number of ambulatory visits per year; total expenditures	Medicare; Medicaid; commercial populations (HMO claims/encounter data)
Pharmacy-based RxRisk	Health-based payment; disease/case management	NDC codes; age; gender	Pharmacy costs; total costs; ambulatory visits	Commercial populations; Medicaid data
Patient self-reported SF-36 measures	Describe morbidity	Clinical data	Ambulatory visits; total expenditures; functional status	Surveys; medical records

ACGs: Adjusted Clinical Groups. DCGs: Diagnostic Cost Groups. CDPS: Chronic Illness and Disability Payment System. HMO: Health Maintenance Organization. NDC: National Drug Codes. SF-36: Short Form Health Survey.