Spotlight Healthcare Risk Models predict future utilization, cost, mortality, and disease within a population. These scores are updated in real time using clinical data from electronic health records, in addition to administrative data from billing and claims systems. The risk models are embedded in our Population Health and Readmission Management applications. There are two categories of risk models: person based and encounter event based.
Person based risk models are used by population health managers to understand each patient or member’s risk of an event in the future 12 month period. These include the following:
- Predicted future cost
- Risk of inpatient admission
- Risk of emergency department visit
- Risk of diabetes
- Risk of stroke
- Risk of AMI
- Risk of hypertension
- Risk of CHF
- Risk of mortality
Encounter event based risks are triggered by an inpatient admission or an emergency department visit. These two risk models run upon admission and in real time show the likelihood of a 30 day readmission for inpatients and a 30 day return to the emergency department for emergency patients.
- Risk of 30 day inpatient readmission
- Risk of 30 day emergency department re-visit