1. Identifying Complex Needs in a Pediatric Population – Part 2
Britta Fuglevand, MSHA - RMHP
December 14, 2018
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2. What is Risk Stratification?
“Risk stratification is an intentional,
planned and proactive process carried
out at the practice level to effectively
target clinic services to patients.”
Asaf Bitton, MD, MPH, FACP, Center for Primary Care at Harvard Medical School
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3. Why is Risk Stratification Important?
Right service
Right Patient
Right Time
Reduce waste
Reduce chaos
Improve outcomes
Do you ever feel like you don’t have enough resources to help all of your patients who need it?
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4. How is Pediatrics different?
Source: Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q Rockville, MD: Agency for Healthcare Research and Quality. April 2014.
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5. Continued
This just demonstrates what we already klno
Source: Lucas JW, Benson V. Tables of Summary Health Statistics for the U.S. Population: 2016 National Health Interview Survey. National Center for Health Statistics
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6. How is Pediatrics the Same?
Resources and support are still needed
Resources, especially time, are limited
Patients and families do not always get the support they need
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7. Change in perspective
We need to change our point of view on the factors for pediatric risk stratification
They should make sense for your population
Credit to Sadie Hernandez,
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8. How to Develop Risk Stratification
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9. Developing a Useful Stratification
Who?
Who are you trying to identify?
What is your population of focus?
Key Components
What are some key components that define that population?
Data Elements
What are the data elements that describe that key component?
Reporting
How can you easily report on that data element?
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10. Example – Preventative Focus
Who?
Who are you trying to identify?
Patients that may have preventable, negative health outcomes in the future
Key Components
What are some key components that define that population?
Adverse Childhood Events
Social Determinants of Health
Healthy Weight, good physical activity and nutrition habits
Data Elements
What are the data elements that describe that key component?
ACEs Score
Family Poverty, Food Insecurity, etc.
BMI %ile, # of sugar sweetened beverages in last 2 weeks, etc.
Reporting
How can you easily report on that data element?
Patients with positive ACE score
Report on Insurance type
Report on patients with BMI%ile increasing in last year
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11. Evaluation ?
What “risk” are you trying to identify? What should your/this tool predict?
How will you know if your tool captures the right populations?
Can you easily measure the elements you want to include in your stratification? If not, how will you include them in your stratification?
What is missing from your tool?
Will it help your providers? Will it help your patients? Will it help your staff?
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12. Practice Examples – Risk Stratification
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13. Risk Stratification for the Whole Patient
CMS concluded after a pilot of 500 clinics (CPCi):
Objective elements
Subjective elements (Clinical Intuition)
Must have a:
Two Step Risk Stratification Tool
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14. Mercy Pediatric Risk Stratification Tool
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15. “We want to identify the patients we can impact”
Western Colorado Pediatric Associates
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16. Your Turn
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17. Brainstorming Discuss at your table: What is your population of focus?
What are some key components that define that population?
How will you know your tool identifies the right people?
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18. Group Discussion What are some key components you picked?
What do you like about your current risk stratification process? What is a challenge?
Other questions?
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19. The Process
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20. What is your process for scoring patients?
Implementation –
What is your process for scoring patients?
How will everyone know what the patient’s risk score is?
What’s the workflow for updating patient scores?
Your goal for stratification should
drive your implementation strategy – run report for the entire population? Score a few patients each day?
Consider what happens after
scoring – will care management be flooded?
How will everyone know what the patient’s risk score is?
Where is the score noted?
Can it be reported?
Workflow for updating patient scores
Annually? At each visit?
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21. Does everyone know why you’re doing risk stratification?
The Big Picture
Does everyone know why you’re doing risk stratification?
Upstream Effects:
How to get good data
How will you pull reports
Consistency between providers and locations
Downstream effects:
Care Management Strategy
Reporting for programs
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22. Questions? Britta Fuglevand, MSHA Britta.Fuglevand@rmhp.org
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