ACO Risk Stratification for Chronic and Disease Management

Importance of Risk Stratification for Chronic Case and Disease Management

Why risk stratification in an ACO?

ACOs have a lot to gain by stratifying patients with chronic cases and high utilization history. After all, when you’re dealing with large-scale population health management, you need to identify specific groups that require your intervention. By categorizing high-risk and high-cost patients, ACOs can dive deeper into these patients and find out how to manage their cases more effectively.

Additionally, risk stratification helps ACOs achieve the following:



• Pinpoint and tackle specific patient population demands
• Allocate the right level of care for high-risk and high-cost patients
• Create case management programs to lower risks and improve patient outcomes
• Ensure your network delivers services that coincide with value-based approaches

Challenges of Risk Stratification for Chronic Case and Disease Management

High-risk patients take up a lot of medical expenses that ACOs and payer organizations need to attend to. Fifty percent of American health care expenses are focused on patients that have complicated medical, behavioral, or social needs, according to a Semantics Scholar article. This means that ACOs need to ensure effective risk stratification for the chronic case and disease management if they want to control utilization costs.

From an ACO’s standpoint, the main objective of risk stratification is to pinpoint patients who need a case management program. By providing the right care management to these patients, they can manage their health independently, minimize redundant utilization, and enhance health outcomes.

Despite their best efforts, ACOs still face a few challenges when it comes to effectively stratifying high-risk populations. Here are some of the main challenges that ACOs face:

• Even when you stratify your population effectively, patients in the same group can still require varying levels of care. As a result, ACOs need to either have a flexible approach to high-risk populations or further divide them into subgroups.
• You may need to further categorize your high-risk populations into smaller groups and provide more specialized programs for them.
• Though risk stratification can help ACOs view the needs of their population more clearly, it doesn’t guarantee that your organization can mitigate costs right at the get-go.
• Risk stratification can only be effective if ACOs also apply value-based strategies that align with the needs of their patient population.

Despite these challenges, ACOs have much to benefit from risk stratification for the chronic case and disease management. The real question is how ACOs can effectively stratify their high-risk population with ease and effectiveness. Luckily, the steady development in computer technology is providing solutions for this specific problem.

How Technology Can Support Risk Stratification for Chronic Case and Disease Management

Major companies are expected to process 60 percent of their business data with advanced computers by 2022, according to a WEF article. If ACOs want to stratify their high-risk population and mitigate clinical expenses, they need to equip themselves with the right technology.

If you want to sort out your high-risk patient population, you need the right data analytics tools. Luckily, advanced management platforms like QuickCap 7 (QC7) have built-in features that are perfect for the job. Put simply, picking the right management platform means instant access to essential features for data gathering, data visualizations, query builders, and reports.

1. Data Analytics and Reporting

The data you need for effective risk stratification is right at your fingertips. From claims information to patient case management details, all you need to do is convert your data into risk management algorithms.

And when you have an advanced system like QC7, you can do that along with the following:

• Easily gather reports based on every population health information you have in your system
• Utilize various search filters and query building features to generate on-point reports
• Keep track of all your patient records, member eligibility, authorization details, claims information, and more.
• Customize user dashboards for your specific workflow needs
• Use different data analytics and visualization tools to view the right data when you need it
  

2. Case Management

From preventive measures to patient-specific care, a case management platform or risk stratification software, allows you to put your risk stratification to action. For example, QC7 has a dedicated case management module that allows you to effectively manage your high-risk cases.

Here are some of the benefits of having a case management platform for your high-risk patient population:

• Utilize a dedicated case management module for effective goal settings and patient-centered care plans
• Use extensive features for triage notes, case reviews, care team coordination, patient records, and more
• Upload organizational documents, such as specialized care guidelines to ensure proper interventions are accomplished
• Easily access reference documents, such as code guidelines and additional patient records, for accurate patient care
• Ensure your care teams take all the right measures and provide the best care for patients

3. Enhance Population Health Management and Risk Management Plans

Having a platform that allows for quick clinical data exchange can mean more complete analytics. With QC7, you can instantly gather crucial information related to your high-risk patient populations. 

With the right management platform like QC7, you have more features that can help you do the following:

• Oversee high-risk patients through a dedicated case management module where you can coordinate with care teams, assign goals, and assess patient productivity
• Utilize extensive built-in report features and data visualization tools to easily analyze trends, predictions, and actionable information
• Ultimately reduce the health-plan-related expenses and control the prices of your premium

How QuickCap 7 Helps with Risk Stratification for Chronic Cases and Disease Management



ACOs that have full control over every aspect of their high-risk and high-cost patients can take better cost-savings decisions. From overseeing the needs of your high-risk population to taking preventive measures, you need a comprehensive healthcare solution like QC7 by your side.