Risk Stratification
Risk Stratification For ACOs
Identify high- and rising-risk patients, close HCC gaps, and prioritize care with confidence.
What is Risk Stratification?
Risk stratification is the process of categorizing patients based on their likelihood of high-cost utilization or adverse health outcomes. By analyzing clinical, claims, and utilization data, ACOs can segment their population into risk tiers—enabling more targeted care management and resource allocation.
Effective risk stratification depends on bringing together fragmented data into a single, trusted source—often referred to as healthcare data aggregation—so insights are complete, accurate, and actionable.
Effective risk stratification goes beyond identifying high-risk patients. It helps organizations:
• Detect rising-risk patients before costs escalate
• Understand the drivers of risk across populations
• Prioritize interventions that improve outcomes and reduce total cost of care
That complete data picture is what makes the difference.
Identify High-Risk Patients with Precision
Detect Rising-Risk Patients Earlier
Close HHC Gaps and
Improve RAF Accuracy
Koan Health has shown itself to be a dedicated partner in our value-based care efforts. Their ability to provide precise and reliable data has been instrumental in advancing our clinical quality initiatives, enhancing our performance, and meeting payers' rapidly evolving data and reporting requirements.
Lee Handke, PharmD, MBA, Chief Executive Officer, Nebraska Health Network
Frequently Asked Questions About Healthcare Risk Stratification
Why is risk stratification important for ACOs?
Risk stratification enables earlier intervention, better care management, and improved cost control by identifying high- and rising-risk patients.
How does risk stratification work?
CMS uses risk adjustment models to assess the acuity of patients within a population, ensuring that payments are appropriately distributed and cost benchmarks are adjusted to reflect the health status and complexity of the population being served. The HCC risk score reflects the patient's demographics (age and gender), diagnoses, and disease interactions as documented in eligible professional claims. Healthcare providers must document relevant chronic and non-chronic conditions annually to reflect each patient’s acuity and ensure appropriate resources to manage their patient populations.
What should ACOs look for in a risk stratification solution?
ACOs should look for solutions that combine integrated data, predictive analytics, and actionable workflows so teams can identify risk early and act on it effectively.
Data-Driven Recovery: A HCC Transformation Story
How an ACO achieved a 12% improvement in HCC recapture rates
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