Using administrative claims data, diagnosis codes and procedure codes, 3M™ Clinical Risk Grouping Software helps you identify and classify patients into clinically meaningful groups for risk adjustment.

3M Clinical Risk Grouping Software (3M CRGS) is a categorical clinical model that uses standard claims data to assign each patient to a single mutually exclusive risk category. Each 3M Clinical Risk Group is clinically meaningful and can be used to predict healthcare utilization and costs on a prospective as well as retrospective basis. 3M Clinical Risk Groups are similar in concept to Diagnosis Related Groups (DRGs), as they can be used to identify clinically meaningful groups of individuals who require similar amounts and types of resources. Insurance companies, health plans and other payers benefit from the methodology because 3M Clinical Risk Groups quantify the total resources used in relation to a specific individual in the future, or in the past, over an extended period of time, while DRGs quantify resources used during a specific hospitalization. 3M Clinical Risk Groups help to:

• Minimize financial incentives for adverse patient selection
• Provide increased incentives for health plans to treat those patients at high risk
• Promote financial and clinical efficiency in healthcare delivery
• Provide a methodology to group patients for retrospective analysis such as benchmarking, rate setting, epidemiological analysis and population risk profiling, especially for chronic care where patients may have multiple hospital and doctor visits over a long span of time

3M CRGS is a powerful tool for targeting cases for care management, tracking patients over time, profiling providers, and enhancing the quality of the care delivered.

How to Use Clinical Risk Groups

Like the Center for Medicare and Medicaid Services DRGs, 3M CRGS provides a means of adjusting payment amounts according to the clinical characteristics and resource demands of patients. Although DRGs and 3M Clinical Risk Groups are both classification systems, DRGs measure inpatient resource utilization. 3M CRGS captures the resource utilization of all inpatient and ambulatory encounters during a chosen time period (usually a year). With the predictive capability of 3M CRGS, payers can easily set rates that minimize inappropriate incentives, and, at the same time, reward hospitals, physicians, and other providers who clinically and financially manage high-risk patients effectively.

Additional information about CRGs:

3M Clinical Risk Groups: Measuring Risk, Managing Care (PDF 483 KB)
3M Clinical Risk Grouping Software for Payers fact sheet (PDF 25.6 KB)
White Paper (PDF 483KB)

For more information, call 800.367.2447 or click here.