In February 2006, the Harvard Business
Review contained its annual list of breakthrough ideas. Among the top 10 ideas was “Seeing the Health in Healthcare
Costs.” The article states, “amid corporate
hand-wringing over rising health care
spending, researchers and a growing number of companies are validating the truth of
a well-known but often-ignored principle,
‘an ounce of health is worth a pound of
health care.’ That is; business can reduce
their overall health care costs through targeted spending to prevent illness and
improve health among their employees.”
By utilizing health risk stratification,
health care organizations are better able to
identify the “at-risk” population and work to
prevent and treat illness and improve health
care, says Sally Stephens, president of
Spectrum Health Systems.
Smart Business spoke with Stephens
about how risk stratification methods are
used to prevent illness, improve health care
and reduce health care costs.
What is health risk stratification?
When risk stratification is applied, the
population is divided into low-, moderate-and high-risk categories. These levels are
used to determine the appropriate level of
intervention. An example of risk stratification is taking the health assessment
responses and classifying the population by
risk. About 20 percent of the population will
be at low risk or have zero to four risk factors. About 40 percent are considered high
risk, having five or more risk factors. The
majority of the population falls into the
moderate risk category. It is important to
look at this data to target interventions
based on individual risk factors and readiness to change relative to those risk factors.
Risk stratification is mostly utilized by
organizations that provide health management or health education. These include
health care organizations, wellness programs and disease management vendors.
How is risk stratification used to prevent illness and improve health?
It is well documented that, as we age, our
health risk and medical costs increase.
Utilizing health risk assessments and ideally
biometric screening data provides the
opportunity to start targeting interventions
and reduction approaches to those individuals in different ways. It is imperative to get a
good profile of the population as a whole.
This requires good participation in the health
risk assessment. The tool must not only
identify the risk but also identify an individual’s readiness to change. This is an indicator
of the potential success of interventions.
How does risk stratification work to reduce
health care costs?
To deflect the cost of chronic care, the
scope of health care has expanded to
include prevention. By utilizing a variety of
tools and methodologies, health care organizations are trying to accurately identify the
population near or in crisis and attempt to
mitigate or prevent complications. This, in
turn, helps reduce health care costs.
Once identified, health care organizations
can develop policies and outreach programs to put at-risk individuals on the road
to health. We know that 50 percent of illness
is preventable and is mostly due to lifestyle
behaviors. Working with individuals to help
them improve their health can have a dramatic impact on stabilizing health care
costs. In fact, research indicates that it’s
about $6,800 for the cost of a high-risk individual compared to about $2,700 for a low-risk person.
Why is implementing risk stratification beneficial to companies?
Risk stratification allows the organization
to provide targeted, risk-level-appropriate
interventions. Providing interventions
based on risk and readiness to change
ensures more effective outcomes. If this
data is not utilized, interventions are random and most likely not as effective. It is
well documented that individuals with five
or more risk factors generate exponentially
higher claims than individuals at low risk.
Therefore, it is critical to identify these individuals, help them improve their health and
to work with those at lower risk to avoid
migration into higher risk categories.
How does one determine which variables to
use in stratification?
Generally, the variables used include alcohol use, blood pressure, blood sugar, cholesterol, emotional health, exercise, nutrition, safety, tobacco use, triglycerides and
weight. It is also important to identify chronic conditions in the population. The criteria
used in each of these areas are based on
nationally accepted guidelines recommended by such organizations as the American
Medical Association and American Diabetes
Association.
Is risk stratification a new method being used
in the health care industry?
Risk stratification is not new; however, it
is used more aggressively today. Organizations have learned they reap the rewards
when they give members the tools and
awareness to combat disease sooner rather
than later. Employer groups want and need
healthy individuals so they are looking to
any avenue possible, and risk stratification
provides them with the best opportunity to
impact health and ultimately cost.
SALLY STEPHENS is the president of Spectrum Health Systems. Reach her at [email protected].
