To succeed in today’s uncertain new world of value-based care, health systems must find the balance of ensuring the healthy remain well, while preventing patients in the “rising risk” segment from getting sicker. This delicate equilibrium can be achieved through innovative, proactive care management strategies that scale care delivery beyond traditional resources.
High risk patient1
5% of the population drives 75% of total costs
This segment refers to patients who have chronic health conditions. As such, this high-risk group should be managed carefully and pro-actively to prevent further complications, and treatment plans should be designed with intervention in mind.
Rising risk1
20% of the population
This significant segment of patients has exacerbating health conditions. To avoid the risk of greater health concerns down the road or current conditions escalating, care plans should integrate preventative screenings and lifestyle or behavioral changes that serve as wellness barometers and allow patients to self-manage their health.
Low risk1
75% of the population
This segment encompasses patients who fit into a well-defined "normal" and healthy range. To ensure the longevity and quality of their health, this group should adopt care strategies that focus on wellness and prevention.
50% of patients designated as high-risk will never recover to a lower-risk status over the course of their lives.2
20% of rising-risk patients transition to the high-risk category each year, with the majority transitioning within three to five years.1
Top rising-risk conditions
- Asthma
- Hypertension
- Heart disease
- COPD
- Congestive heart failure
- Diabetes
Prioritizing the rising-risk patient population
In order to keep patients healthy and prevent rising-risk patients from developing chronic conditions or having their conditions worsen, hospitals and health systems must focus on patient goals that drive the behavior changes required to transform their disease trajectory and improve long-term health outcomes. Addressing the rising risk population is critical because they hold the key to profitability. Some 18-20% of this population will enter the ranks of the high-risk, highest cost group of patients if there is no focused interventions and outreach.
Beyond the cost implications, staffing this approach is a challenge and the math quickly becomes staggering. Consider this: current estimates recommend 200:1 caregiver to patient ratio when focusing on the high-risk population. For today's Medicare population, and those 30 million patients with multiple chronic conditions, that could mean hundreds of thousands of care managers required nationally. The goal is to help rising-risk patients from becoming top utilizers while scaling resources.
