Prioritized List of Health Services Methodology
Developed by the Health Services Commission (HSC)
As of January 1, 2008, the Prioritized List reflects a ranking of health services based on a new methodology that places a higher emphasis on preventive services and chronic disease management. The new methodology ensures a benefit package that provides the services necessary to best keep a population healthy rather than waiting until an individual gets sick before higher cost services are offered to try to restore good health.
The prioritization methodology first defines a rank ordered list of nine broad categories of health care to establish a basic framework for the list (see Figure 1.1). Next the methodology calls for each of the line items on the Prioritized List to be assigned to one of these health care categories. Once the line items have been assigned to one of the nine categories, a list of criteria is used to sort the line items within the categories (see Figure 1.2). These measures are felt to best capture the impacts on both the individual’s health and the population health that is essential in determining the relative importance of a condition-treatment pair.
Since not every service in Category 1 is more important than every service in Category 2 and so on, a weight is applied to each category that is then multiplied by the total criteria score for each condition-treatment pair, achieving an appropriate adjustment in the majority of the cases. The category weights are shown in parentheses after the title for each category in Figure 1.1. A total score is then calculated for each line using the following formula to sort all line items within each of the health care categories, with the lowest net cost used to break any ties:
Hand adjustments were applied by the Commission where the application of this methodology did not result in a ranking that reflected the importance of the service, which was the case in fewer than 5% of the line items (compared to over 70% of cases using the previous methodology).
Services near the top of the list as a result of this reprioritization include maternity care and newborn services, preventive services found to be effective by the U.S. Preventive Services Task Force, and treatments for chronic diseases such as diabetes, major depression, asthma, and hypertension, where ongoing maintenance therapy can prevent exacerbations of the disease that lead to avoidable high-intensity service utilization, morbidity, and death.