Data Sheet: What Is a Chronic Illness & Disability Payment System+Rx (CDPS)

The Chronic Illness & Disability Payment System (CDPS+Rx) is a sophisticated predictive modeling tool developed by the University of California Department of Family and Preventive Medicine. Designed to forecast medical costs over a one-year period, CDPS+Rx leverages both diagnostic (ICD-10 codes) and pharmacy (NDC codes) data. Its primary objective is to predict the severity of costs, with higher predicted costs indicating greater severity.

Built using Medicaid claims data, CDPS+Rx excels in accurately predicting costs for Medicaid patients. The model offers both prospective and concurrent predictions, with sub-models tailored for adults, children, and disabled individuals. The prospective model is exclusively used for future risk assessments.

CDPS+Rx Features

Diagnostic & Pharmacy Components:

CDPS encompasses 20 major diagnostic categories related to different body systems or types of diagnoses, further subdivided based on the severity of associated costs. The Rx component includes 15 major categories to refine risk calculations where diagnostic data may be absent but pharmacy data is available.

Integration with GuidingCare®

Integrated into GuidingCare®, CDPS+Rx can operate independently or alongside other risk measures to generate a comprehensive risk score. This score helps in stratifying members into critical, high, medium, or low-risk categories. The algorithm processes medical and pharmacy claims data monthly, ensuring up-to-date risk assessments.

Customization and Flexibility

GuidingCare® also allows for the customization of the CDPS risk score by incorporating additional elements such as Health Risk Assessment (HRA) scores, gap counts in care, and other external risk metrics like CMS HCC scores. These factors can be blended with the CDPS score using user-defined weightings, customizing the risk assessment to specific health plans.

For healthcare professionals and organizations aiming to enhance their predictive accuracy and optimize resource allocation, CDPS+Rx offers a robust, data-driven solution.

Learn more about how integrating CDPS+Rx can revolutionize your healthcare cost predictions and patient management strategies.