Alan Thompson and Chris Morris: Risk Stratification. 30 June 2014

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In this slideshow, Alan Thompson, Benefits Realisation Manager and Chris Morris, Information Analyst at Central Southern Commissioning Support Unit, give an outline of their work regarding risk stratification at Central Southern CSU , identifying four mail roles for stratification and describing how they developed new models of predicting risk with the Adjusted Clinical Groups (ACG) system. Alan Thompson and Chris Morris spoke at the Nuffield Trust event: The future of the hospital, in June 2014.

Text of Alan Thompson and Chris Morris: Risk Stratification. 30 June 2014

  • 1. 1 The Wider Use of Risk Stratification Methodology Alan Thompson Chris Morris Central Southern Commissioning Support Unit 30th June 2014 1

2. Introduction Initiated our work on risk stratification in early 2010 4 years experience of all aspects from primary care data extraction, IG, grouping of data, predictive models, visualisation and reporting and how to use the information a& intelligence Use the Johns Hopkins Adjusted Clinical Groups (ACG) System Purpose of todays short talk is to give you a flavour of what were doing and signpost you to where you can get more information 2 3. Central Southern CSU Working Definitions Within the CSU we make the distinction between: Patient level risk stratification -. The outputs are used by clinicians for the purposes of supporting direct patient care eg case management. The information produced describes each patients overall morbidity and their risk of particular outcomes such as risk of emergency admission and risk of high cost in the coming year and Population level risk profiling The outputs of this process are used by non-clinical staff for the purposes of supporting commissioning activities. The information produced provides information about disease and risk prevalence and distributions across wider populations and can be used to inform planning and service redesign activities 3 4. Role of Risk Stratification & Risk Profiling We have identified four main roles for the use of risk stratification, risk profiling and risk adjustment methodologies: 1. To support case finding activities - finding suitable patients from all levels of the risk pyramid for the various services and care programmes being provided 2. To support population profiling - undertaking population profiling analyses to better understand the current and future health needs of the whole population and commission services accordingly 3. To support resource management and our understanding of relative performance - using risk and case-mix adjustments to enhance the way in which we benchmark performance and understand comparative performance 4. Potentially to support a more equitable formula for resource allocation - thinking about a new and more equitable approach to the allocation of resources 4 5. Recalibration of Models In 2013 we worked with JHU to recalibrate predictive models within the ACG System Also developed a model to predict risk of emergency admission and incorporated that into the ACG System software Now have the ability to develop new models in the future or add new variables as they become available More information about this work is available on the flyer 5 6. Case-mix Adjustment 7. Total Primary Care Utilisation Top 1% of population (100th percentile) uses 10% activity Top 5% of population (96th percentile) uses 30% of activity 8. Association between Primary Care Utilisation and Secondary Care Cost Primary Care Utilisation Non-user 16% 0% 1% Low 30% 7% 5% Moderate 17% 11% 8% High 18% 21% 17% Very High 13% 29% 30% Extremely High 6% 33% 40% People Total Primary Care Activity Total Secondary Care Cost 9. Multi-morbidity and Primary Care Utilisation Chronic Conditions 0 24% 39% 17% 13% 5% 1% 1 7% 25% 21% 26% 17% 5% 2 2% 10% 15% 29% 31% 14% 3 0% 4% 9% 25% 37% 25% 4 0% 2% 5% 18% 37% 38% 5 0% 1% 3% 13% 34% 49% 6 0% 1% 2% 9% 29% 60% 7 0% 0% 1% 7% 24% 68% 8+ 0% 0% 1% 3% 16% 79% Primary Care Utilisation Non-user Low Moderate High Very High Extremely High 10. Distribution of total cost incl. indicative Primary Care cost 11. Distribution of Total Cost Against Predictions 12. More Information More information about our work from: Alan Thompson alan.thompson10@nhs.net Chris Morris chris.morris2@nhs.net Please pick up copies of the two flyers that weve brought with us Participation in one of the two webinars weve scheduled on: Friday 18th July 13.00 14.00 or Monday 21st July 13.00 14.00 If you would like to participate in one of the webinars, please give Chris or I your contact details over lunch 12 13. Thank You Any Questions? 13