Health Enrollment Assessment Review 1.0 (HEAR): High Resource Utilization (HRU).

The Health Enrollment Assessment Review 1.0 HEAR is a self-report health assessment instrument. The HEAR incorporates the high resource utilization HRU algorithm to categorize respondents by their expected level of future health care resource utilization High, Medium, or Low. This study examined a cohort of 7,596 beneficiaries who completed the HEAR and were continuously enrolled in TRICARE during the succeeding twelve months. Total health care costs were mostly derived from the Corporate Executive Information System CEIS. The findings indicate that the HRU algorithm is not sensitive enough to correctly identify high-cost enrollees. It is a poor tool for identifying individuals for utilizationcase management or other cost-control interventions. However, it can identify which groups are likely to incur relatively higher or lower costs. Thus, the HRU algorithm could be used to risk-adjust different groups or populations. The HRU could most likely be improved by modifying the algorithm and categorization scheme. Future studies should use multiple regression analysis to derive a mathematical model for determining an HRU score. The HEAR HRU algorithm should include coding to identify missing and conflicting responses, and produce an invalid HRU outcome. Coding should also flag specific questions to allow primary care teams to evaluate and follow-up.