Table 5.

Predicted losses for subgroups based on HCE in 2000–2004

	No risk adjustment	Demographic model	Prior LTC model	Prior HCE and DCG model${}^{\mathrm{a}}$	Full model	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
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 medical equipment in prior year	4,108	949	185			93	693,144
Expenditures on medical equipment in prior 3 years	6,524	1,846	320				330,813
Expenditures on medical equipment in prior 5 years	7,259	2,057	326				211,030
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
Expenditures on paramedical care in prior year	2,409	1,319	107			53	246,233
In top 15 % in prior 3 years: paramedical care	3,635	2,009	350				91,743
In top 15 % in prior 5 years: paramedical care	4,371	2,338	462				51,218
In top 15 % in prior year: pharmaceuticals	2,832	572	130			28	701,221
In top 15 % in prior 3 years: pharmaceuticals	3,215	678	140				482,222
In top 15 % in prior 5 years: pharmaceuticals	3,448	742	147				381,160
No prior HCE available	$-$445	25	17				1,450,876
DCG 1	2,080	$-$272	$-$1,474				22,198
DCG 2	1,921	466	117				27,820
DCG 3	2,400	349	117				14,018
DCG 4	10,172	6,865	1,145				11,358
DCG 5	5,109	2,189	471				17,981
DCG 6	3,821	1,346	276				10,586
DCG 7	4,595	3,512	1,215				7,391
DCG 8	6,187	3,881	1,033				7,027
DCG 9	4,787	3,231	9,78				7,459
DCG 10	7,602	5,840	3,275				5,365
DCG 11	7,461	6,220	3,823				2,939
DCG 12	5,275	3,536	1,805				2,684

All reported predicted losses are significant at the p $<$ 0.05 level

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