Why population health and value-based care are driving risk stratification

By Susan Morse
03:08 PM

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. "It stratifies you for claims data, demographic information, into medium, high and low risk. 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.

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Identifying high-risk consumers, for instance, lets providers know who may become a user of inappropriate services, such as the emergency room, Nagrath said.

"It makes sure they're being taken care of at right time and helps contain costs," he said. "Something as simple as drug adherence."

Most of the time, healthcare providers don't know if a patient is taking the prescribed medication.

"But 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 manage it really, really 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're trying to understand the highest risk category and why they are at the highest risk."

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 Ferburary 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 get providers to the Triple Aim."

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.

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