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Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices.

To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future.

The cost of unmanaged cardiac conditions

One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage.

With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average total costs were astronomically higher for these patients:

Finding tomorrow's high-risk patients today

Next, the ACO looked at probabilities for hospitalization within high-risk patient profiles. It found that two out of three patients have a cardiac condition. Analytics revealed that cardiac patients who had not seen their primary care provider within the last three months had 21% more emergency room use and 51% more hospitalizations.

While the primary concern is making sure these patients receive the best care possible, there is also a financial component: overall costs for these patients is 48% higher than patients who regularly see their primary care providers.

This data represents an opportunity to better manage care for cardiac patients. If the ACO can get these patients to more consistently visit their primary care providers through care coordination and patient engagement efforts, it could potentially save as much as $12.7 million per year. Even if the ACO could only affect change with one out of every ten patients, it would save more than $1 million.

We can help you find unmanaged opportunities within your own healthcare community. Contact us for more information.

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About the author

Mike Hofmeister is Vice President, Value-Based & Community Solutions. In this role, he is responsible for Value-Based Care and ACO solutions and sales for Allscripts across the United States. Mike has more than 20 years of experience in the healthcare information technology industry. He joined Allscripts in January 2000 as a Regional Sales Executive in the company's Central Region. Since that time, he has assumed positions of increasing responsibility within sales management, expanding his coverage of products in the US as well as managing the Channel Partner program for the US. Mike began his career at Ernst & Young where he worked in Advisory and Compliance Services primarily in Health Care and Financial Services. Mike holds a BS in Business Administration & a BS in Accounting from the University of Kansas.

2 COMMENTS on Finding tomorrow’s high-risk patients

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mirorna says:

02/24/2016 at 2:03 am

High-risk patients? AIDS?

Mike Hofmeister says:

02/25/2016 at 10:36 am

Thanks for your question, Mirorna. By high-risk patients, I mean people who have one or more serious chronic conditions, such as diabetes, heart disease or asthma. These patients are at higher risk for poor health outcomes than patients without those chronic conditions.

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