Data presents challenges in stratifying high risk patients


While the tactic of stratifying high-risk, high-cost individuals is championed in a value-based industry, it faces a number of challenges.

The procurement of clinical data and verifying data integrity are the top challenges of segmenting patients by health risk, according to a new HINtelligence report.

One-third of organizations stratifying patients by health risk report reductions in hospital readmissions.

Most critical to the process of segmenting patients by health risks for care coordination purposes is the availability of rich clinical patient data, say an overwhelming 87 percent of respondents to the survey, titled Stratifying High-Risk Patients.

However, obtaining and verifying patient data remain major challenges in the stratification process for many respondents, who view risk segmentation as integral to value-based care.

Across the healthcare continuum, a range of tools and practices help to identify and stratify high-risk, high-cost patients and determine appropriate interventions.

Two-thirds of healthcare organizations responding to HIN's September 2014 survey currently risk-stratify the populations they serve.

In addition to the requirement for clinical information, hospital discharge data (62 percent) and pharmacy data (49 percent) are also highly sought in the risk stratification process.

Hospital readmissions was the metric most favorably impacted by health risk stratification, according to respondents; 65 percent reported a decrease in hospitalizations as a result of patient segmentation.

Melanie Matthews, HIN executive vice president and chief operating officer, said: "Identification and care coordination of high-risk, high-cost patients is an essential first step in population health management. When leveraged organization-wide and supported by care coordination protocols, patient segmentation has been shown to improve cost and quality outcomes, thus enhancing value-based reimbursement."

HINtelligence, US, Melanie Matthews