Table 2.

Predicted losses for selected subgroups

	No risk adjustment	Demographic model	Prior LTC model${}^{\mathrm{a}}$	Prior HCE and DCG model${}^{\mathrm{a}}$	Full model${}^{\mathrm{a}}$	Incentive compatible model${}^{\mathrm{a}}$	Subgroup size
Demographic information	No	Yes	Yes	Yes	Yes	Yes
Prior LTC use	No	No	Yes	No	Yes	Yes
Prior HCE and diagnosis information	No	No	No	Yes	Yes	Yes
Subgroups of LTC users in prior year
Personal care	16,992*	8,293*		7,269*			82,116
Nursing	25,799*	17,183*		15,303*			24,727
Nursing home: combined care 1–90 days	31,009*	23,310*		20,888*		21,005*	10,546
Nursing home: combined care 91–180 days	51,350*	42,482*		39,803*			3,853
Nursing home: combined care 180–365 days	71,408*	61,349*		59,290*			4,359
Nursing home: combined care 366 days	85,868*	74,655*		74,693*			12,439
Receiving home care on last day of 2004	10,078*	2,459*		1,669*		876*	172,291
Subgroups based on HCE in 2000–2004
In top 15 % in prior 3 years: hospital + outpatient care	3,410*	1,804*	278*				137,618
In top 15 % in prior 5 years: hospital + outpatient care	4,031*	2,321*	393*				57,597
Expenditures on transportation in prior year	7,350*	4,271*	582*			916*	201,609
Expenditures on transportation in prior 3 years	9,040*	5,753*	353*				43,615
Expenditures on transportation in prior 5 years	8,565*	5,347*	374*				22,462
DCG 4, e.g. Cardiovascular accident, stroke, angina pectoris	10,172*	6,865*	1,145*				11,358
Subgroups based on diagnosis information from 2004 hospital admission data
Dementia	30,423*	20,777*	9,255*	20,114*	9,274*	11,692*	821
Hip fracture	21,225*	12,029*	$-$950*	9,167*	$-$1,229*	3,205*	6,433
Chronic ulcers of skin including decubitus	13,421*	8,676*	$-$224	4,514*	$-$1,897*	$-$1,528*	873
Stroke	10,840*	7,288*	1,109*	2,219*	327*	1,271*	11,998
Heart failure	10,054*	3,806*	858*	745*	182	637*	8,147
Diabetes mellitus including diabetic complications	6,478*	4,633*	679*	2,770*	133	231	4,746
Asthma and COPD	6,128*	3,721*	876*	122	$-$78	26	8,035
Subgroups from POLS health survey (n = 4,619)
Has difficulty to/cannot perform $\ge$1 ADL	16,221*	8,918*	357	7,887*	289	532	90
Cannot perform $\ge$1 ADL	23,365*	13,476*	1,479	11,906*	1,409	1,365	32

${}^{\mathrm{a}}$ Cells are empty if variable is included in this extension of the risk adjustment model

*Significant at the p $<$ 0.05 level