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The real contribution of risk adjustment models comes from those identified by models alone, because these subjects may not be known without applying risk adjustment models ( Supplementary data, area a in Appendix D ). The last approach to assess the model performance is to examine the medical utilization of the identified top groups, including 2005 average total costs and the trend ratio of total costs (2005 cost divided by 2004 cost in the top identified group).

A better model will have higher total costs, and higher trend ratio of costs (subjects with costs increasing over time are better targets for intervention).

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