Understanding the High Prevalence of Low-Prevalence Chronic Disease Combinations: Databases and Methods for Research. University of California, San Diego Grouper System

09/20/2013

Chronic Illness and Disability Payment System (CDPS)

References:

1 Kronick RG, Gilmer T, Dreyfus T, et al. Improving Health-Based Payment for Medicaid Beneficiaries: CDPS. Healthcare Financing Review, 2000;21(3):29–64

2 Kronick RG, Bella M, Gilmer TP, et al. The Faces of Medicaid II: Recognizing the Care Needs of People with Multiple Chronic Conditions. Center for Healthcare Strategies, Inc., October 2007.

Sponsorship: University of California, San Diego
Description: The Chronic Illness and Disability Payment System (CDPS) is tool used to summarize diagnosis codes that are reported on health care claims, and is primarily used by Medicaid programs to make health-based capitated payments for Temporary Assistance to Needy Families (TANF) and disabled Medicaid beneficiaries.1
Purpose/Use: CDPS is a tool used by Medicaid programs to adjust payments to health plans based on the health status of enrollees.
Coding Family: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)
Grouping Methodology: CDPS groups ICD-9-CM into 20 major categories of diagnoses, which correspond to individual body systems or specific diagnoses, such as cardiovascular disease or diabetes. The CDPS further divides these 20 categories into several subcategories based on the degree of increase expenditure associated with specific diagnoses ( e.g., High-cost, medium- cost, and low-cost).
Level of Diagnosis Aggregation: 20 categories of diagnoses that correspond to body systems or diagnoses.
Number of Codes Included: 11603
Number of Codes Excluded: 2969
Methodological Considerations: CDPS was originally designed as a payment tool. It was not designed as a tool for diagnostic profiling because it excludes a number of diagnoses that are ill-defined (e.g., diagnoses the clinicians may disagree about due to the presentation of the patient). The CPDS system does not analyze laboratory or radiology claims because these sources are considered to contain “rule-out” diagnoses.
Related Data Sources: CMS Claims data (Medicaid)
Used in Disease Complexity Research: Yes2

 

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