Chilmark: Risk calculations have to change with value-based care

Researchers point to 'Total Active Risk' model to better address care coordination, patient activation.
By Bernie Monegain
09:21 AM

Risk stratification, Chilmark researchers explain, is a foundational element of care management and population health management.

BOSTON – The value-based healthcare system emerging today will require new models of risk assessment, concluded Chilmark Research in a new report released today.

The risk stratification models in place today are not up to the task, the researchers concluded. Value-based care requires a new approach - one that moves beyond the simple, claims-based models in use today.

The report, Evolution to Total Active Risk: New Tools and Strategies to Deliver on Value-Based Care, stressed the importance of capturing a patient's “Total Active Risk” profile.

Risk stratification, Chilmark researchers explained, is a foundational element of care management and population health management. It needs to evolve in-step with value-based care objectives, which shift the focus from the volume to quality of care - improving patient outcomes, while reducing the overall cost.

Healthcare organizations have to incorporate information about social, behavioral and environmental factors into their risk stratification models in order to better understand a patient's risk.

[See also: Health Catalyst: Only 3 percent of hospitals meet CMS target for value-based care.]

Traditional risk models developed from clinical, claims and utilization data just won’t cut it. They only account for 10 percent of a patient's overall health outcomes, according to Chilmark.

Adding data about the social determinants of health, which account for about 70 percent of health outcomes, also assists in another key step in population health management: patient activation. By using a much broader data set, organizations can identify more care gaps than they would in a traditional risk model. Also, they can gain better insight into individual drivers of patient engagement, which can help providers match patients to interventions, services or resources most likely to improve outcomes.

"Current risk models were largely developed for actuarial purposes,” noted Jody Ranck, lead author of the report. “We now know claims and clinical datasets are not enough to effectively predict true risk for all high utilizers, and it's essential for future business success to incorporate additional measures to accurately manage the need for current and future services.

Today, there are only a handful of healthcare organzations and vendors tackling this problem, she added, and those that do it well will have a significant competitive advantage in the coming years.

The report provides a five-year roadmap for the adoption of the Total Active Risk model and presents case studies highlighting four vendors leading the transition from traditional risk models - Forecast Health, Health Catalyst, SCIO Health Analytics, and Verisk Health.