Table 1. Risk-Adjustment Models.
| Model | Description | Maximum Number of Diagnostic Categories for Individuals* |
|---|---|---|
| Demographic Model | ||
| Adjusted Average Per Capita Cost (AAPCC) | Includes age, sex, and Medicaid status, as used in Medicare's current method of paying HMOs. | 0 |
| DCG Models | ||
| Principal Inpatient Diagnostic Cost Group Model (PIPDCG) | Pays for the single highest-cost principal inpatient diagnosis in addition to AAPCC factors. | 1 |
| All-Diagnoses Diagnostic Cost Group Model (ADDCG) | Pays for the single highest cost hospital or physician diagnosis in addition to AAPCC factors. | 1 |
| HCC Models | ||
| Hierarchical Coexisting Conditions Model (HCC) | 34 (prospective) or 44 (concurrent) Hierarchical Coexisting Conditions, plus age and sex. | 23** |
| Hierarchical Coexisting Conditions and Procedures Model (HCCP) | 40 (prospective) or 44 (concurrent) HCCs, 11 Procedure-Based HCCs, plus age and sex. | 33 |
| Hierarchical Coexisting Conditions, Procedures, and Hospitalizations Model (HCCPH) | 40 (prospective) or 39 (concurrent) HCCs, 11 Procedure-Based HCCs, and 3 (prospective) or 5 (concurrent) Principal Inpatient HCCs, plus age and sex. | 36 |
*
Prospective or concurrent version of the model.
**
For concurrent HCC model, maximum number is 25.