Cerner expert: Population health, value-based care driving need for risk stratification
While it may not sound all that exciting at first blush, a working knowledge of the low-, mid- and high-risk stratification of populations is key to successfully moving toward value-based care.
“The way stratification works is based on medical history and health history,” said Gaurav Nagrath, a senior strategist of population health and analytics at Cerner. “The population is classified into designated risk groups using claims data, clinical results, health assessments, and demographic information to predict future health risk levels and health care spend levels. Your highest risk patients are hard to manage without concerted effort.”
Getting the needed stratification for population health models requires analytics, some of which are already available, Nagrath said. Registration and claims data are among the resources that can show the risk attributes of a population.
Identifying high-risk consumers, for instance, lets providers know who may become a user of inappropriate services, such as avoidable emergency room visits, Nagrath said.
“It makes sure they’re being taken care of at right time in the right care setting and helps contain costs,” he said. “Something as seemingly simple as drug adherence.”
Most of the time, healthcare providers don’t know if a patient is taking the prescribed medication.
“If you have a care plan, and a care manager who’s calling, making sure that they’re complying, or making sure they’re coming in for monthly visits, then you can start managing complex conditions well,” Nagrath said. “When non-compliance starts happening, they’re not taking their meds, you start getting into episodes of high cost care.”
The next step is to address what providers do with the information once they know the high-risk patients, he said.
“Right now we’re in the middle of understanding the population,” Nagrath said. “We are beginning to identify the ‘at-risk’ population cohort.”
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Nagrath and Michael Aratow, MD, chief medical information officer at San Mateo Medical Center, will talk about the broad spectrum approach being taken at the health system in the move to value-based care at HIMSS16, which kicks off on February 29, 2016 in Las Vegas.
Nagrath and Aratow will also address the need for providers to have an integrated data warehouse to reduce the lag time to actionable knowledge; having targeted metrics which educate and inform meaningful action; and creating risk models which give population disease patterns and preemptive risk assignments.
In performance programs, Nagrath said, providers are dependent on data and metrics, trying to nudge the shift from volume to value by focusing on understanding the issues involved; understanding the role of restratification in the process; and understanding the part innovation plays.
“Changing data into knowledge that can be used in the clinical workflow,” Nagrath said, “will propel our healthcare system closer to Triple Aim objectives.”
Aratow and Nagrath’s session, “The Drive Toward Value Based Care,” is scheduled for Thursday, March 3, 2016 from 8:30-9:30 AM in the Sands Expo Convention Center Palazzo E.
This story is part of our ongoing coverage of the HIMSS16 conference. Follow our live blog for real-time updates, and visit Destination HIMSS16 for a full rundown of our reporting from the show. For a selection of some of the best social media posts of the show, visit our Trending at #HIMSS16 hub.