The Ven of Risk: Start in the Red Zone

Here’s a way to jump-start how you manage care in Value-based Care: Start in the Red Zone.

Stratifying patients by their medical, behavioral, psychologic, and social risks can help achieve optimal outcomes for the patients at greatest risk and will have the greatest financial impact (this should not be confused with risk coding where a patient’s burden of illness is documented and dropped on a claim). Risk stratification informs the decision as to which resources are needed and to whom are they applied.

If you want to be more successful in creating value in healthcare but can’t afford a fancy-schmancy AI risk strat tool, here’s a place to focus: The Ven overlap of Chronic Fragile Conditions, Mental Health, and Obesity.

The Ven of Risk

Chronic fragile conditions are what we often refer to as Ambulatory Sensitive Conditions like diabetes, heart failure, CAD, and COPD. Under the best of conditions, these patients walk a fine line between stability and decompensation which can lead to ED and inpatient utilization and excess medical expense.

It is well-documented in the medical literature that their journeys are more arduous (and expensive) when they have concurrent mental health issues like depression or anxiety. Plus, all these conditions are made worse when accompanied by obesity – insulin resistance, restrictive lung disease, compromised venous return, elevated blood pressure, and so on.

All three of the circles are tracked by discrete coded information in an EMR. Most EMRs can do a search of patients by condition. Finding these patients in the red zone should be just a few clicks away. Plus, you don’t need to rely on the disparate and often confusing claims data from the payers to identify these high-risk patients.

Is this a perfect risk stratification system? Of course not. But it’s fast, no extra cost, and can lead you to a group of patients in need of high touch management of their care. It can get you started.

Setting plans of care for these patients and applying resources to help them, well, that’s another story. Interestingly, though, I’ve seen more organizations with resources to manage care, but no way of knowing the priority of patients in need of those services. Start in the Red Zone.