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Determining Patient Risk or Complexity

CPS, C-EMR, PM

Last Post by Anonymous 1 second ago

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joeg1962

(@joeg1962)

Posts: 843

Noble Member

Topic starter

Often when assessing patients, empanelment, etc..., it would be useful to have a method for determining the risk or complexity of each patient. For instance, a 21 year-old with no meds and no active problems is easier to care for then a 67 year-old with diabetes, COPD, elevated cholesterol, and history of frequent ED visits.

So, trying to determine a good way to assess patient risk/complexity. Has anyone written something, perhaps in Crystal Reports, to list each patient (in a group) and calculate a risk score?

About the best basis I have found so far is published online technical reference from Johns Hopkins (Dec 2009) that groups EDC's (expanded diagnostic cluster) into high, medium, low impact.

Or, does anyone have alternate suggestions or approaches?

Thanks.

Posted : September 19, 2019 5:45 am

bhoover

(@bhoover)

Posts: 360

Honorable Member

You could use the HCC scoring the CMS uses to determine patient risk. Using that metric might help you with incentive programs depending on your situation. We don't have anything coded to calculate each patient's risk value. I haven't been able to find good documentation on how to do that. However, third party programs do so. We use ENLI and I believe they provide that score.

Posted : September 19, 2019 7:48 am

jcollins

(@jcollins)

Posts: 107

Estimable Member

bhoover,

where in enli products is there a risk score

JJC

Posted : September 21, 2019 2:17 pm

bhoover

(@bhoover)

Posts: 360

Honorable Member

It's in the CareManger Registry. That is a separate component that you may or may not have signed up/paid for.

Posted : September 23, 2019 12:38 am

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