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Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics

A new report from the Healthcare Intelligence Network presents a range of risk stratification practices to to identify and manage super utilizers, improve health outcomes and reduce healthcare spend.

Sea Girt, NJ, September 18, 2014 --( To fully thrive in a value-based system, healthcare organizations must identify high-risk, high-cost patients and members for targeted population health interventions. Recently, CMS has funded initiatives targeting “super-utilizers”—beneficiaries with complex, unaddressed health issues and a history of frequent encounters with healthcare providers.

Stratifying High-Risk, High-Cost Patients: Benchmarks, Predictive Algorithms and Data Analytics presents a range of risk stratification tools and analytics to determine candidates for health coaching, case management, home visits, remote monitoring and other initiatives designed to engage individuals with chronic illness, improve health outcomes and reduce healthcare spend.

Each program discussion is supplemented by market data on risk stratification approaches for that care coordination intervention.

This 30-page report compiles risk stratification profiles for a range of programs from such industry leaders as Humana, Adventist Health, Taconic Professional Resources, Monarch Healthcare (a Pioneer ACO), Stanford Coordinated Care, Ochsner Health System and others.

Accompanying each risk stratification profile are HIN market metrics from 2013 and 2014 on the top methods for identifying candidates for these interventions, based on responses from hundreds of healthcare organizations:

Learn more about stratifying high-risk, high-cost patients and super utilizers at

News Facts: Industry experts provide details on the following:

-How Humana's predictive algorithms peg candidates for remote monitoring;
-How Taconic connects high-risk, high-cost patients to case management;
-Carolina Behavioral Health Alliance's template for telephonic outreach to behavioral health populations;
-Adventist Health’s seven tools to identify groups for population health
-How Ochsner Health System recruits candidates for health coaching;
-How Stanford Coordinated Care prioritizes high-risk patients for home visits
-HCSC's outreach efforts to locate duals for care and service planning;
-Structuring a clinic's workflow to maximize health coaching results;
-Overcoming the barriers to health coaching in this new environment;
-Tracking HEDIS measures to ensure quality goals are met;

and more.

Learn more about stratifying high-risk, high-cost patients and super utilizers at

Target Audience: Presidents, CEOs, medical directors, quality improvement executives, health coaches, care coordinators, business development and strategic planning directors and consultants.

Report Formats: Print, PDF or Enterprise Site License.

Quote Attributable to Melanie Matthews, HIN Executive VP and COO:
"Health risk stratification is the cornerstone of population health management and a crucial prerequisite to success in a system increasingly partial to value-based reimbursement. Stratifying high-risk, high-cost patients can improve all-important quality and improvement metrics like avoidable emergency room visits and 30-day readmissions among Medicare beneficiaries."

Please contact Patricia Donovan to arrange an interview or to obtain additional quotes.

About the Healthcare Intelligence Network — HIN is the premier advisory service for executives seeking high-quality strategic information on the business of healthcare. For more information, contact the Healthcare Intelligence Network, PO Box 1442, Wall Township, NJ 07719-1442, (888) 446-3530, fax (732) 449-4463, e-mail, or visit
Contact Information
Healthcare Intelligence Network
Patricia Donovan

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