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
Length: 4:25 minutes