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Mental Health Risk Adjustment with Clinical Categories and Machine Learning

Objective: To propose nonparametric ensemble machine learning for mental health and substance use disorders (MHSUD) spending risk adjustment formulas, including considering Clinical Classification Software (CCS) categories as diagnostic covariates over the commonly used Hierarchical Condition Category (HCC) system.

Data Sources: 2012–2013 Truven MarketScan database.

Study Design: We implement 21 algorithms to predict MHSUD spending, as well as a weighted combination of these algorithms called super learning. The algorithm collection included seven unique algorithms that were supplied with three differing sets of MHSUDrelated predictors alongside demographic covariates: HCC, CCS, and HCC + CCS diagnostic variables. Performance was evaluated based on crossvalidated R2 and predictive ratios.

Principal Findings: Results show that super learning had the best performance based on both metrics. The top single algorithm was random forests, which improved on ordinary least squares regression by 10 percent with respect to relative efficiency. CCS categoriesbased formulas were generally more predictive of MHSUD spending compared to HCCbased formulas.

Conclusions: Literature supports the potential benefit of implementing a separate MHSUD spending risk adjustment formula. Our results suggest there is an incentive to explore machine learning for MHSUDspecific risk adjustment, as well as considering CCS categories over HCCs.

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