Using Risk Segmentation for Change

March 30, 2018

Today, more than ever, healthcare has an increased focus/love on big data, predictive analytics and artificial intelligence.  While these shiny objects may have some promise now and in the future, they are generally expensive, time-consuming and may or may not affect change in a positive manner.  Before beginning any analytics or data project, my question is always “how are you going to use the results?”  or “how does the information improve the health of my patients?”  Powerful software, Terra gigs of data, and social determinants of health do not matter unless you have plan to implement its use. 


In a current project, we developed a framework for clinicians to assess and communicate the behavioral health or substance use risk of patients.  The system, albeit simple, offers providers within an organization and with partner providers a common language on patient risks and needs.   A patient in Tier 1 has the ability to self manage and advocate providing insight not only into the behavioral health or substance use risk, but also the ability to comply with a care plan, get to an appointment, and engagement.   On the flip side, a tier 3 patient needs advanced access and wrap around support (transportation, housing or med assist).  Furthermore, the risk of the patient may and will change over time as they work through a behavior health crisis or episode and the support for that patient can adjust up or down.


A partner organization can use this “language” to prioritize patients in terms of access and resources and design systems of care for patients to meet the needs of a patient population during a vulnerable time.  The system is not data intensive or overly sophisticated in terms of algorithms and predictive value.  It is based on the clinical and experiential judgment of the clinicians interacting with each patient allowing for a team to implement better care across a care continuum and use limited resources wisely.




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