Top 5 videos from HIMSS17

Top 5 videos from HIMSS17

Medical Home Network deploys predictive risk stratification to pinpoint high-utilization patients

The Chicago-based nonprofit’s methodology taps historical claims data along with real-time behavioral and social determinants data to better control costs by identifying patients likely to need care.
By Chris Nerney
07:08 AM
predictive risk stratification

Healthcare providers serving low-income populations face a number of challenges, including identifying which patients are most likely to utilize healthcare resources in the future. Being able to identify these potential high-utilizer patients allows providers to better coordinate clinical activities, improve outcomes, and determine cost of care.

While historical claims data provides some indication of a patient’s future hospital utilization, it is of limited use. To gain greater predictive insights, some hospitals and provider networks are developing and deploying risk stratification methodologies to identify patients most in need of care coordination resources.

Medical Home Network (MHN) is one example. The Chicago-based nonprofit organization allows disparate providers to connect, communicate and collaborate around patient-centered care.

MHN’s dynamic and predictive risk stratification methodology uses both historical claims data and real-time behavioral and social determinant data, which is proven to be predictive of subsequent utilization and cost of care.

A major indicator is a patient’s adherence to a treatment plan. That can be impacted by transportation difficulties, inability to cover a co-pay, depression, substance abuse, and other lifestyle, economic, or logistical factors.

“The idea was to see if we could use those impactful barriers to care to refine a risk stratification code to identify who are actually going to be the high utilizers,” said Art Jones, MD, chief medical officer of MHN. “So in addition to getting a patient’s demographic information and historical use of the emergency room, we ask about 11 risk factors we could impact. We found out that these are indicative of subsequent hospital utilization and total cost of care.”

Jones said MHN’s work fits into “part of a value-based payment opportunity tied to managing total cost of care and shared savings,” that includes payers trying to refine risk stratification algorithms, hospitals and IT vendors.

MHN, for its part, has already helped to improve value and outcomes with the predictive risk stratification and a team-based model of care to successfully deliver medical, behavioral and social services in one of the largest Medicaid settings in the U.S.

In a HIMSS17 session titled “Prioritizing Care Coordination for Patients Who Need It Most,” Jones and Cheryl Lulias, president and executive director of the organization, will discuss MHN’s approach and the impact that can be identified at a patient level.

“Prioritizing Care Coordination for Patients Who Need It Most” is scheduled for Monday, Feb. 20, 2017 from 1:30 to 2:30 p.m. EST in room 303A.

HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.

This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.

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