Chilmark Research Redefines Risk Stratification For Value-Based Care

New "Total Active Risk" Model Incorporates Social Determinants of Health to Better Address Care Coordination, Patient Activation

Today's risk stratification models are not up to the task of addressing the needs of tomorrow's healthcare organizations (HCOs). The migration to value-based care (VBC) requires a new approach that moves beyond the simple, claims-based models in widespread use today.

Chilmark Research's latest report, Evolution to Total Active Risk: New Tools and Strategies to Deliver on Value-Based Care, emphasizes the importance of capturing a patient's Total Active Risk (TAR) profile. Risk stratification is a foundational element of care management and population health management (PHM). It will need to evolve in step with VBC objectives, which shift the focus from the volume of care provided to the quality of that care in improving patient outcomes while reducing the overall cost of care.

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. HCOs 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.

Adding data about these social determinants of health, which account for about 70 percent of health outcomes, also assists TAR in another key step in PHM: patient activation. By using a much broader data set, HCOs can identify more care gaps than they would in a traditional risk model. In addition, HCOs can gain better insight into individual drivers of patient engagement, which can help providers match patients to interventions, services, or resources that are most likely to improve outcomes.

As Jody Ranck, lead author of the report notes, "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 HCOs and vendors tackling this problem, and those that do it well will have a significant competitive advantage in the coming years."

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.

This report is available to subscribers of the Chilmark Advisory Service or may be purchased separately. For more information, visit www.chilmarkresearch.com/reports.

About Chilmark Research:
Chilmark Research is the only industry analyst firm focusing solely on the most transformational trends in healthcare IT. We combine proven research methodologies with intelligence and insight to provide cogent analyses of the emerging technologies that have the greatest potential to improve healthcare. We do not shy away from making tough calls, and are respected in the industry for our direct and thoughtful commentary. For more information, visit www.chilmarkresearch.com/.