Healthcare organizations are under growing pressure to provide effective preventive care for the entire population they treat and their financial success will be predicated on their ability to improve outcomes at lower costs. Risk stratification is a foundational element of care management and population health management (PHM) and will need to evolve in step with value-based care objectives. The days of clinicians viewing what happens beyond the clinical walls as none of their business are soon to be over and risk stratification methodologies are an important window into the changes to come and how clinical teams and care managers will need to partner to offer better preventive care.
In this report we examine where risk models are now and where major vendors and new entrants into this space are headed with risk stratification efforts in the coming years. Current reliance on claims data and more static models that arose out of payer-led efforts will shift dramatically over the next several years. There is growing demand for better care coordination, identification of high-value care gaps, and customization of interventions to individual contexts and risk stratification will be asked to do the heavy lifting in providing the analytics to accomplish these objectives. Risk management will move from a focus on identifying high-risk patients to identifying the interventions with the highest probability of impact on outcomes.
The report provides a five-year roadmap for the adoption of Total Active Risk and presents case studies highlighting four vendors leading the transition away from traditional risk models – Forecast Health, Health Catalyst, SCIO Health Analytics, and Verisk Health.
Providing strategic insight, this report will be valuable to anyone interested in the role that risk stratification and patient activation can play in helping the healthcare industry achieve the goals of VBC. HCOs, payers, healthcare IT vendors, consultants, investors, and others will all benefit from this in-depth report.