The shift towards value-based care (VBC) is profoundly reshaping the healthcare landscape, and the momentum is palpable. Payments with value-based models increased from 30 percent to 40 percent between 2016 and 2021, a testament to the transformative journey the industry is undertaking. Influenced by multifaceted challenges, including the seismic impact of the COVID-19 pandemic, this change places a heightened focus on holistic health, patient outcomes, and cost efficiency. One crucial realization central to this transition is the significant role played by non-clinical factors, notably the social determinants of health (SDOH), which contribute to a staggering 80–90% of health outcomes. Addressing these determinants becomes paramount to achieving a more comprehensive understanding of patient health, refining patient engagement, and dismantling barriers to care.
Illustration is by Mike Werner
VBC is characterized by its alignment of financial incentives with health outcomes and necessitates a streamlined and technologically fortified healthcare ecosystem. Zyter|TruCare is a leading advocate for this alignment, offering a compliant, scalable product suite that drives the delivery of quality care cost-effectively. More than just adapting to change, we empower healthcare organizations to stay nimble in an ever-evolving healthcare landscape, enabling them to provide superior patient care while optimizing costs.
The Synergy Between Risk Stratification and Population Health
Risk stratification takes center stage as an indispensable facet of VBC, categorizing patients based on health indicators and histories. Gartner highlights the critical role of population health management, particularly emphasizing the comprehensive risk stratification model. Risk stratification, which encompasses categorizing patients into high, moderate, and low-risk groups based on potential clinical complications, is intricate and requires methodical execution. To accomplish this, one needs access to objective data and the involvement of healthcare providers who deeply understand their patients and their conditions. What is the goal? Utilizing risk scores to optimize patient management and efficiently deploy available resources
While state-of-the-art algorithms play a role in this process, pinpoint accuracy remains a challenge that Zyter|TruCare is committed to addressing.
To implement population management effectively, healthcare practices must differentiate patients requiring specific types and intensities of care. Implementing effective population management entails a consistent approach to routinely assessing the needs of each patient, paired with a plan of care that supports those unique needs.
When risk stratification converges seamlessly with population health, it becomes a critical lever of VBC. These components, together, bolster community outcomes, predominantly drawing from data in electronic health records. However, this collaboration has its challenges; gaps in patient insights sometimes emerge due to challenges in data integration. Zyter|TruCare stands ready to tackle these issues, ensuring the maximum potential of this crucial alliance is realized.
Risk stratification is a pivotal process in value-based care, employing multiple layers and steps to ensure the comprehensive assessment and categorization of patients. Each layer involves specific steps that enrich the stratification process:
- Clinical Layer:
- Begin by compiling a list of health center patients for evaluation.
- Sort patients by condition, focusing on direct health indicators and patient histories. This foundational categorization sets the stage for more profound stratification.
- SDOH Layer:
- Examine non-clinical factors significantly impacting a patient’s health, such as their living environment and socio-economic conditions.
- Stratify patients based on these determinants, pinpointing those who might benefit from particular social or community-based interventions.
- Consumerism Layer:
- Focus on the patient’s journey and preferences within the healthcare ecosystem. Are they more digitally inclined, or do they prefer traditional settings?
- Further, segment the population based on these preferences, ensuring healthcare delivery matches their comfort and expectations.
Concluding the process, insights from all layers and steps lead to the design of care models and interventions tailored for each risk group. This culmination, the Composite Risk Score, is a tool Zyter|TruCare leverages to ensure healthcare interventions align with each patient’s multifaceted profile.
By understanding patients through these integrated layers and steps, Zyter|TruCare champions providing care that resonates with everyone’s unique narrative and requirements.
Redefining Risk Stratification with Zyter|TruCare
In the evolving healthcare landscape, Zyter|TruCare is set on pioneering the future of value-based care. Central to our vision is the relentless pursuit of recognizing individuals at pivotal health moments and crafting comprehensive solutions tailored to their health journey. Our Population Health™ platform embodies this vision, aspiring to ensure that individuals encounter transformative care exactly when it matters most through:
- Patient Segmentation Analysis: Beyond detecting potential health risks, we are advancing our platform to segment patients into specific risk tiers adeptly. This advancement aims to make care provision laser focused. We endeavor to provide clients with the capability to shape program eligibility, create distinctive member risk scores, categorize patients based on their health intricacies, and direct them seamlessly to the proper care teams.
- Evolving Our Risk Stratification Methodology: The value we seek to provide starts with meticulous risk stratification. We continuously refine our approach to help clients pinpoint the right care level for distinct patient subgroups, knitting connections between these groups, pivotal care providers, and in-house care teams. This ongoing refinement paves the way for consistent care and communication models customized for every individual’s health journey and related care costs.
- Shaping Value-Based Organizational Models: As healthcare shifts, we are positioning our platform as a lighthouse for organizations navigating value-based care. We aim to redefine health risk categorizations, project costs more precisely, design targeted interventions, evaluate health literacy, discern lifestyle choices, and understand care modality preferences. Our vision encompasses active involvement in chronic disease management, preventive wellness, adapting care models, and relocating patients into best-fit cohorts serviced by specialized clinical teams.
- Harnessing Advanced AI and Analytics: Our goal is to utilize machine learning and AI to distill extensive data sets, revealing innovative patterns and refining the assignment process for patients and providers. We’re enhancing our analytics engine to grant stakeholders a panoramic view of clinical and financial metrics, driving insightful decisions for the Risk Pool, Provider Pool, Care Team, or Care Program.
- Building for Adaptability and Scalability: We’re architecting our platform to echo industry benchmarks and exhibit unparalleled adaptability and scalability. This design will respond to the dynamic nature of healthcare, effortlessly categorizing groups, determining Risk Scores for each entity, and recalibrating them as underlying data shifts, molding any external care provider into a network based on performance and quality.
- Crafting Optimal Assignment Solutions: Through our Assignment Management blueprint, we aspire to bridge targeted Risk Pools with apt Provider Pools and Care Teams, devising exceptional Care Programs. By aligning clinical workflows with engagement patterns, we aim to harness peak outcomes, integrating future results into continually evolving scoring and assignment practices using AI.
The essence of Zyter|TruCare’s vision lies in fortifying our risk stratification abilities. This commitment lays the foundation for deeper patient engagement, more proactive healthcare interventions, and data-driven decision-making at scale. We are passionate about empowering healthcare entities to adapt and lead in an era of healthcare innovation and efficacy.
Mapping the Path Ahead
As the healthcare sector pivots towards delivering greater value, the significance of understanding population health and the nuances of risk stratification cannot be overstated. Zyter|TruCare stands at the forefront of this transformation, providing healthcare professionals with essential tools and insights to solve healthcare’s most complex challenges with confidence and agility.
In this transformative journey, challenges such as refining risk prediction, enhancing patient engagement, and adhering to regulatory standards are evident. However, the path forward is promising with Zyter|TruCare as your partner. Together, we are committed to shaping a future where healthcare adapts and thrives, delivering better outcomes and experiences for patients and providers alike. Embrace the future with Zyter|TruCare and join us in improving healthcare.
