Stratify Your Patient Panel

Once you have selected a risk stratification methodology, you must then apply that methodology to your assigned panel. Implementing risk stratification will require an investment of time for those on the project team due to the initial evaluation and validation of the methodology.
Resource Type: 
  • Guide
Topic(s): 

    REFERENCES

     

    Risk Stratification: A Study of CPC Practice Approaches, August 1, 2014

    American Academy of Family Physicians, Risk-Stratified Care Management Rubric, 2012

    REFERENCES

    Introduction:

    In addition, you will need to develop an ongoing process to complete the initial assignment of risk in addition to re-evaluating your patients periodically.

    Regardless of which stratification methodology you select, confer with the physician and the care team to identify the top ten patients they worry about ending up in the emergency department or being admitted to the hospital in the next two weeks.

    Steps to take:

    Assign Risk Status Manager

    Assign a Risk Status Manager to pull patient listings by provider from your electronic medical record or registry. This individual will have access to document and update patient risk status.

    Sort Patient Listings

    Sort the patient listings into two groups: those with diagnosis codes and those without.

    • Those patients without diagnosis codes may fall into your low risk category and those with diagnosis codes may fall into your moderate risk category.

    Sort Based on Diagnosis Codes

    Sort those with diagnosis codes based on the number of diagnosis codes present.

    • These patients may move to the high-risk category.

    Compare

    Compare these listings to the additional data sources available, e.g. payer claim or utilization data, known physical or mental limitations, current medications, social determinants, and anecdotal information from the physician and the care team.

    Re-assign

    Re-assign patients based on the additional data collected.

    Plan for Today

    Review completed list to determine if your Top 10 patients have been classified as high-risk.

    • If your Top 10 patients have not been stratified as high-risk, look at their data compared to those who are stratified as high-risk. What’s different or missing? Is the difference due to the methodology or data collection?

    Review

    Review the patients listed in each category to ensure your methodology has accurately and consistently stratified your patients.

    Make Adjustments

    Make any adjustments necessary based on the review and discussion with the care team.

    Establish a Process

    Establish a process for stratifying new patients and for monitoring and updating the risk status of existing patients.

    Other Considerations:

    For High-Risk Patients:

    • Identify protocols for scheduling high-risk patients that will ensure they are accessing the right care at the right time rather than inappropriately using urgent or emergency departments.
    • Identify which patients will be referred for dedicated care management services and how that will be documented in the EMR

    For Moderate-Risk Patients:

    • Identify which patients may be considered “rising-risk” and without intervention or support could escalate to high-risk.
    • Establish interventions to prevent rising-risk patients from becoming high-risk.

    How Can We Help Your Team Work?