Is the High-Moderate-Low Financial Risk Model Enough to Drive Effective Population Health Management?
Traditional population stratification risk models focus primarily on the groups of individuals currently generating the greatest cost. While these methods help pinpoint individuals most at-risk for critical events and in need of immediate intervention, they do not allow for long-term goal setting and health improvement strategies for the remainder of the population. Total population health management programs demand stratification models that allow for targeted intervention strategies for the full spectrum of individuals. It is essential to reach each person at specific points along his or her healthcare journey in order to prevent the onset and delay progression of chronic conditions. The utilization of intervention strategies for broader population groups could potentially increase the effectiveness and success of chronic care management service delivery and improve clinical outcomes.
A deeper approach to population stratification picks-up where traditional high-moderate-low risk models fall short. The Care Pathways approach, also known as Clinical Pathways or Integrated Pathways, is a process management approach to patient care. The general pathways design concept was born from adaptations of industrial process management methods in the form of program evaluation and review techniques (PERT) and the quality measurement approach, Six Sigma. Following its early development this design methodology has been adapted and applied to various forms of case management, telehealth, and home care. i
Health Dialog’s Care Pathway framework has its roots in these approaches and has been enhanced with medical guidelines used in evidence-based practice and powerful analytics. Health Dialog adopted the design and integrated wellness and disease management program frameworks to develop stronger analytics, which support 100% of a population across disease states. The resulting framework drives more targeted and personalized patient engagement efforts by segmenting individuals into nine clinically-relevant population subgroups within a disease trajectory, versus the traditional high-moderate-low medical cost risk buckets. Risk-based stratification frameworks may ignore individuals at well or sick ends of a disease trajectory and overlook their unique care needs as well as financial opportunities. This advanced approach recognizes both imminent financial risk and the future financial risk lying with segments of the population that would benefit from long-term clinical interventions.
A recently developed white paper, A Clinical Approach to Population Stratification Analytics discusses in more detail how health plans, employers, and other purchasers would benefit from developing a long-term approach to population health management. The case study demonstrates:
- How a Care Pathways stratification analysis increases the opportunities for clinical interventions today, which ultimately means reducing avoidable medical costs in the future.
- The limitations of using high predicted medical costs as a means to develop outreach thresholds for effective population health management programs, and
- The limitations of using high financial risk as a means to predict the likelihood of costly sentinel events for individuals with chronic conditions.