Preventing Hospitalizations – Risk Stratification Analytics Part 8

Preventing Hospitalizations – Risk Stratification Analytics Part 8

What are some of the more difficult parts of your population health efforts? Perhaps it is team members spending more time on aggregating data rather than working on improvements. Or maybe it is not about time but quality as you are not able to get the right kind of data, like being able to proactively identify patients that need a preventative screening in the next three months. Using data to improve service delivery does not have to be a painful process. KPI Ninja clients using the Johns Hopkins ACG® System get the right information, quickly and easily.

One of the more common value-based goals is trying to keep patients out of the hospital. Using analytics that help you identify patients in your population that have hospital dominant morbidity and are more likely to seek out inpatient care makes it easy.

What is Hospital Dominant Morbidity?

Hospital dominant morbidity include diagnoses that, based on expert clinical review, are associated with a high likelihood of hospitalization in the next year. Presence of these conditions have been proven to increase the likelihood of hospitalization, in addition to other factors in the ACG System predictive models. Here are examples of some diagnoses that are included in hospital dominant morbidity:

Taking a patient-centric approach, the ACG System looks at a patient’s aggregate set of diagnosis codes and unique clinical criteria to capture the range and severity of morbidity to identify patients that have hospital dominant markers.  

How Can I Use Hospital Dominant Markers?

Hospital dominant markers can be used in several different ways to help you, either alone or in combination with other predictive markers and clinical indicators.

Example 1
A flag within a patient-level report to help a care manager know who to target for intervention. Displaying probability scores alongside pertinent clinical indicators can help sort case management worklists by business priority and give case managers a view of priority patient needs prior to outreach.

Example 2
Stratify your population based on hospital dominant counts to better understand health trends. An organization focused on preventing hospitalizations may wish to focus efforts on the 8% of patients with the greatest number of hospitalization-associated conditions.

Example 3
As an added variable in other analytics, like creating a “High Medical Needs” cohort that includes patients with at least five chronic conditions, a frailty flag, and a hospital dominant marker.

How Does this Help Me?

The count of hospital dominant markers can be used as a powerful predictor of high resources use in the next year. To give you a sense of the impact, let’s take a national, cross-section of managed care plan with over three million commercial and Medicare beneficiaries data, and look at the impact of hospital dominant markers on next year’s hospitalization risk and total health care costs.

The number of hospital dominant morbidity types dramatically increases the likelihood of hospitalization, and subsequently, total health care costs too.

We are now in an industry where most health care organizations and providers have multiple value-based contracts and plenty of incentive to reduce hospital admissions. And this is why, KPI Ninja’s technology paired with the ACG System offers a meaningful and simplified way to help you reach your goals by providing interoperability-enabled analytics that reduces burdens and is fit to your unique needs.


Renee Towne

About the Author
Renee Towne
Director of Quality Programs at KPI Ninja, Inc.
Renee provides operational leadership of quality initiatives at KPI Ninja. Towne has a background in occupational therapy, education and experience in operational excellence across a variety of healthcare domains. Based on prior experience as a clinician that drove outcomes patient by patient, she is leaving a larger footprint by improving health care more comprehensively, population by population.


About KPI Ninja
KPI Ninja is a data analytics company that helps healthcare organizations accelerate their quality, safety, and financial goals with a unique combination of software and service. We are differentiated by our signature mix of technology, performance management consulting and healthcare expertise. We don’t merely offer software solutions but work shoulder to shoulder with clients to help them draw on the power of analytics and continuous improvement methodologies to become more efficient. In harmony with our data-centered ethos, we truly believe that our success is strongly co-related with yours.

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