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.
With that foundation, organizations can:
- 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
A complete, unified data picture is what makes effective risk stratification possible.
What Challenges Do ACOs
Face with Risk Stratification?
Despite its importance, many ACOs struggle to operationalize risk stratification in a meaningful way.
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Risk stratification outputs are often lists—not prioritized, actionable insights tied to care workflows or broader financial performance.
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Risk scores are often outdated by the time they are used, limiting their effectiveness for real-time decision-making.
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Most tools focus on high-risk patients, missing the opportunity to intervene earlier with rising-risk populations.
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Clinical, claims, and utilization data are often siloed, making it difficult to create a complete view of patient risk without strong data integration.
Uncaptured conditions result in inaccurate RAF scores and missed opportunities for both care optimization and reimbursement.
How Koan Health Improves
Risk Stratification
Koan Health delivers a more advanced approach to risk stratification—combining integrated data, predictive analytics, and actionable workflows.
Identify High-Risk Patients with Precision
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Stratify patient risk relative to national benchmarks and your population
Identify common conditions and comorbidities driving complexity
Segment high-risk patients for targeted screenings and interventions
Understand utilization patterns and chronic condition prevalence
Engage providers to proactively manage high-risk populations
Detect Rising-Risk Patients Earlier
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Forecast future risk, cost, and utilization using predictive models
Identify rising-risk patients before they become high-cost
Detect “movers” in your population based on changing conditions or utilization
Enable earlier, lower-cost interventions
Close HCC Gaps and Improve RAF Accuracy
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Calculate HCC risk scores aligned to each patient’s CMS eligibility model
Identify suspected and uncaptured conditions
Understand what’s driving changes in risk severity
Review diagnosis codes and encounters tied to HCCs
Align providers and care teams around gap closure priorities
Why Koan Health Is Different
Most risk stratification tools generate scores. Koan Health helps you understand what’s driving risk—and what to do next.
Natively Unified Data—Not Bolted Together
Koan Health integrates clinical, claims, and utilization data in a single platform, eliminating the need to reconcile fragmented sources.
Risk, Cost, and Utilization—Connected
Understand not just who is high-risk, but how risk is impacting cost, utilization, and overall performance.
Cohort-Level Intelligence
Analyze trends across populations to identify patterns, anomalies, and emerging risk—not just individual patient scores.
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Deep Drilldown Visibility
Move seamlessly from population-level trends into second-level service line insights and patient-level detail to understand what’s driving change.
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Built for Action, Not Reporting
Prioritized patient views and workflow alignment ensure insights translate directly into care team action.
What You Can Achieve With Koan Health
With Koan Health Risk Stratification, ACOs can:
- Intervene earlier with high- and rising-risk patients
- Improve RAF accuracy through more complete HCC recapture
- Reduce avoidable utilization by acting on emerging risk sooner
- Focus care management resources where they will have the greatest impact
- Gain clarity into the drivers of cost and performance across your population
ACO Population Health Analytics: Risk Stratification for Shared Savings Performance
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Frequently Asked Questions For Risk Stratification
What is risk stratification in healthcare?
Risk stratification is the process of categorizing patients based on their likelihood of high utilization or adverse health outcomes. By analyzing clinical, claims, and utilization data, providers can segment populations into risk tiers and prioritize care management efforts more effectively.
Why is risk stratification important for ACOs?
Risk stratification enables ACOs to identify high- and rising-risk patients, intervene earlier, and allocate resources more effectively. This leads to improved outcomes, better quality performance, and reduced total cost of care.
How does risk stratification work?
Risk stratification works by aggregating clinical, claims, and utilization data to create a complete view of each patient’s health status and risk profile. Patients are then segmented into risk tiers based on factors such as chronic conditions, utilization patterns, and predicted future cost.
More advanced approaches go further by:
- Continuously updating risk scores as new data becomes available
- Identifying rising-risk patients whose utilization or conditions are changing
- Highlighting suspected HCC gaps and documentation opportunities
- Connecting risk insights to cost and utilization trends
This allows ACOs to move beyond static risk lists and instead prioritize interventions based on where risk is increasing and where action will have the greatest impact.
What is the difference between high-risk and rising-risk patients?
High-risk patients already have complex conditions and high utilization, while rising-risk patients are those whose health status or utilization patterns indicate they are trending toward higher risk. Identifying rising-risk patients early creates an opportunity for proactive intervention before costs escalate.
What should ACOs look for in a risk stratification solution?
ACOs should look for solutions that integrate clinical, claims, and utilization data, provide continuously updated risk insights, and connect those insights to actionable workflows. Koan Health has 30+ years of experience helping ACOs identify rising-risk patients and understand drivers of cost and utilization, which is critical to improving performance.
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Turn Risk Insight Into Action
See how Koan Health helps you identify risk earlier, close gaps, and improve outcomes.
