As value-based care becomes the primary focus of healthcare organizations, providers now need to broach Population Health Management and to manage it with risk stratification with a delicate balance. It is now important for providers to focus on patients’ individual and distinct health signs and take decisions to take their journey forward to better and quality health.
Before providers deliver care, they should have a prior knowledge of who their patients are, identifying them and finding who needs the care most. In this era of value-based care, risk stratification becomes a necessity: to sort patients into high, moderate and low health risk tiers and delivering appropriate care to address their health needs.
The Need for Risk Stratification
Risk stratification, to put simply, is the process of dividing patients into “buckets” based on their vital health signs, their lifestyles, and medical history. Risk stratification is a framework applied for complete population health management, combining several individual risk scores, demographic and socioeconomic characteristics and medical records to create a comprehensive patient profile.
Risk stratification is the foundational step for targeting patients at various levels of risks, and further, scheduling follow-ups and keeping them aligned with their care plans. Here’s why risk stratification is important:
All in all, it’s the need of the hour to implement risk stratification in any successful population health management model to classify patients into high-risk, low-risk, and rising-risk groups and to achieve the Triple Aim: better health outcomes, quality care and lower costs of care.
Overview of Risk Stratification Methods
There are several models available to stratify a population by risk. Here are a few widely used and recognized ones. :
The Use of Data
Data analytics is the current buzzword in healthcare, and rightly so. Access to actionable data combined with right analysis helps not only in predicting outcomes, but also improves the ability of care teams to align available resources to what a patient needs. Although data is just a start and not an endpoint, it can be used in several ways to make the process of risk stratification less cumbersome.
A value-focused organization used Medicaid data, along with real-time hospital admissions, discharge, and transfer data (ADT) from about 80% of hospitals across the state with the aim to provide more than 1800 Primary Care Practices with insights into patient risk status and population health trends. Within the last one year, their efforts have been rewarded with a 5 percent drop in total Medicaid costs along with a 26 percent reduction in inpatient admissions and half the number of preventable readmissions.
The Road Ahead
Risk stratification, in all true sense, is a catalyst in developing successful population health management plans. Only an effective implementation of risk stratification combined with communication and monitoring will guarantee appropriate patient-centric care. The availability of data is not an issue; even the access to data is a challenge that can be combated. The real challenge is transformation – it needs more than analytics and insights; it calls for actionable plans from providers, payers, and patients.