Using HIOs for Prospective Care Management: Patient Risk Score Assignment

The healthcare industry has used risk stratification and risk scores for a few years, in order to proactively manage the care of patients with the highest needs. Risk scores can be used, for instance, to identify patients at risk for developing specific diseases, at risk for a worsening of a disease they already have, or the risk of hospital readmission. Typically scoring has been developed by payers utilizing claims data, which is limited in detail and may not be available when patients face the highest risk—after a prior medical encounter—due to the delay in submission and processing of claims. Some health information organizations (HIOs) are also developing risk assessment services that complement other offerings and enhance their value proposition to participants.

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