Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model

Predictive modeling and health risk stratification can help providers identify members for case management and disease management interventions, says Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc. These methods ensure that patients receive treatment for their chronic conditions early on and, in turn, reduce unnecessary utilization and lower acute and chronic care costs.

Health claims are still scrutinized during risk stratification, but today’s analysts examine these data points through a slightly different lens, explains John Harris, chief wellness officer and senior vice president for Healthways. Harris explains why the focus has shifted from ICD-9 coding patterns to the financial trends evident in the claims, and what accelerating or decelerating costs reveal about an individual’s health status.

Dr. Vennart and Harris described how their organizations have approached health risk stratification, from how individuals are identified for stratification purposes to the effectiveness of risk stratification programs during a May 6, 2009 webinar, Reducing Acute and Chronic Care Costs Through an Effective Health Risk Stratification Model.

Dr. William Vennart



Length: 4:30 minutes
John Harris



Length: 4:25 minutes

The Strategic Ongoing Role of Disease Management in the Healthcare Continuum: Achieving the ROI


Nightly data mining has helped Vanderbilt University and Medical Center identify and make contact with high-risk high-volume patients, explains Dr. Dexter Shurney, which has vastly improved patient outcomes and closed care gaps. But the medical director of Vanderbilt’s Employee Health and Care Plan would like to see even more data put in front of physicians at the point of care — especially regarding certain patients with no claims history. Dr. Shurney describes these “bombs waiting to explode,” as well as the impact of the patient-centered medical home (PCMH) model of care on disease management and why wellness and prevention services may be the best responses to individuals with comorbidities.

Dr. Shurney, along with Dr. Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group, examined how disease management programs can continue to prove their worth and new developments in disease management that are netting results during The Strategic Ongoing Role of Disease Management in the Healthcare Continuum: Achieving the ROI.


Length: 10:42 minutes