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Risk Stratification Models Must Include Social Determinants of Health, New Report Finds

June 17, 2016
by Rajiv Leventhal
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Current risk stratification models are not up to the task of addressing the future needs of healthcare organizations, and should be adding data about patients’ social determinants of health, according to a new report from Chilmark Research.

Indeed, the migration to value-based care (VBC) requires a new approach that moves beyond the simple, claims-based models in widespread use today, according to the report, Evolution to Total Active Risk: New Tools and Strategies to Deliver on Value-Based Care. The report provides a five-year roadmap for the adoption of total active risk and presents case studies highlighting four vendors that are transitioning away from traditional risk models. The vendors were Forecast Health, Health Catalyst, SCIO Health Analytics, and Verisk Health.

According to the research, 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. As such, 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.

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, providers can identify more care gaps than they would in a traditional risk model. In addition, Healthcare organizations 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 said, "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."

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