When we investigated the overlap between grouping methods, we found that patients defined within the LCA highest acuity group were redistributed to the frail elderly (25%), older with cardiovascular disease (17%), pain management (17%), and the new, eighth k-means cluster (16%) (which we characterized as primarily patients with obesity and diabetes requiring insulin), suggesting that k-means clustering did not separate by acuity. This evidence concerns the gene INS and obesity due to melanocortin 4 receptor deficiency.