Even the healthiest among us would benefit from some level of care management, but resources are limited and patients must be stratified to facilitate prioritized enrollment into care management programs. Therefore, health systems need to identify not only high-cost, high-risk, and rising-risk patients, but also patients who are truly impactable.
This article explains how systems can use healthcare analytics, at varying levels of maturity, to improve patient stratification and, ultimately, achieve the gold standard:
Level 1 (where to start): use healthcare analytics to identify high-cost, high-risk patients in a population.
Level 2: use healthcare analytics to identify patients with rising-risk profiles.
Level 3 (highest level of maturity): use healthcare analytics to identify patients who are truly impactable (the patient stratification gold standard).
Analytics is key to achieving the patient stratification gold standard, but should enhance (not replace) clinical judgement. Stratification lists need to go through workflows in which clinicians remove patients that aren’t appropriate for enrollment.