Risk stratification is one of the fundamental competencies needed for risk-based contracting. Failure to master the ability to anticipate which patients will be at high risk for expensive utilization patterns in the coming years can mean financial doom for providers under value-based care (VBC) economics.
Today’s challenge is that most risk models were developed for payers and HCOs to find equitable means to pay physicians. With our latest report, Evolution to Total Active Risk: Tools and Strategies to Deliver on Value-Based Care, we define the next evolution of risk stratification tools that will provide a holistic view of the healthcare consumer and aid in more effectively and efficiently channeling patients through appropriate care paths.
Current reliance on claims data and more static risk models that arose out of payer-led efforts will shift dramatically over the next several years. There is a growing realization that not only must an organization identify risk, but concurrently identify the “impactability” of a patient to align resources for care management activities.
This report charts the trajectory of risk stratification tools from the payer-led models into the realm of value-based care and population health management. Total Active Risk (TAR) goes beyond the risk stratification models dominated by claims and clinical data to looking at the social determinants of health. Understanding these determinants and their impact on the ability for a patient to self-manage their health will increasingly become a key differentiator for healthcare organizations.
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.