Value-based care requires a new risk approach: Chilmark

Current risk stratification models are not up to the task of addressing the needs of tomorrow’s healthcare organizations.

This is the finding of Chilmark Research’s latest report, ‘Evolution to Total Active Risk: New Tools and Strategies to Deliver on Value-Based Care’, which added that the migration to value-based care requires a new approach.

With risk stratification a foundational element of care management and population health management, it’s vital that it will need to evolve with the development of value-based care objectives and move beyond the simple, claims-based models currently used. 

The report emphasizes the importance of capturing a patient's total active risk (TAR) profile.

“It is well recognized in the industry that traditional risk profiles developed from clinical, claims, and utilization data only account for 10 percent of a patient's overall health outcomes,” said the report.

“Healthcare organizations must therefore incorporate information about social, behavioral, and environmental factors into their risk stratification models in order to better understand a patient's total active risk.”

Chilmark explained that adding data about these social determinants of health, which account for about 70 percent of health outcomes, also assists total active risk in another key step in population health management: patient activation.

By using a much broader data set, HCOs can identify more care gaps than they would in a traditional risk model, said the report.

Jody Ranck, lead author of the report, added: "Current risk models were largely developed for actuarial purposes. We now know claims and clinical datasets are not enough to effectively predict true risk for all high utilizers, and it is essential for future business success to incorporate additional measures to accurately manage the need for current and future services.

“Currently there are only a handful of healthcare organizations and vendors tackling this problem, and those that do it well will have a significant competitive advantage in the coming years."

The report also 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.