Pop Analyzer: Stratify

Pop Analyzer™: Stratify provides a seamless process for stratifying populations using multiple pre-defined, easily customized populations and predictive risk models as building blocks. The speedy data lifecycle takes the stratified population data from ad-hoc analysis and development to an integrated analytic workflow—supported by the Data Operating System (DOS™)—within minutes, not days. Pop Analyzer: Stratify also harnesses the power of the John Hopkins ACG® System—an industry-leading risk adjustment model that offers a complete classification system to describe population health in terms providers can understand and interpret.

Pop Analyzer: Stratify enables you to bring in predefined populations so you can easily help prioritize patient interventions.

The problem

Identifying the right patients for population health interventions is critical to any population health initiative. Not having an accurate, transparent, and flexible stratification model,
organizations sometimes struggle to maximize the impact their population health team has
on the overall populations they manage. Teams don’t understand the algorithm that defines the population—and they can’t modify population definitions—leaving them unable to confidently demonstrate that they are identifying the right patients.

In addition, it can take months to properly create complex stratification algorithms that truly use analytics to target the right patients for the right interventions. According to a recent study, analysts spend over 50% of their time completing a non-analytics task (preparing SQL/ETL data, repeating tasks, and performing simple tasks) instead of focusing on
high-impact analytics like targeted stratification.

Our approach

Pop Analyzer: Stratify enables anyone within an organization to efficiently and accurately identify patient groups based on pre-defined—yet easy-to-customize—populations and risk algorithms. Members of the care team have complete transparency into the algorithm behind population definitions—and they can easily adjust those definitions on the fly.

Pop Analyzer: Stratify provides the architecture and toolkit to integrate the stratified populations into the population health workflow. Along with the ACG System, Stratify provides predictive capabilities and risk assessments to help prioritize patient interventions—improving patient health and financial outcomes.

Benefits and features

• Grow your ecosystem. Seamless integration with the Health Catalyst ecosystem of workflow and self-service analytic tools drives a complete care management program.
• Predict patient risk. Leverage an evidence-based risk stratification model to maximize the impact and target interventions optimally. See the Johns Hopkins ACG System data sheet for more information.
• Access a library of content. A growing list of pre-defined content, including over 6,000 value sets, 21 predefined chronic condition registries, ED utilization (integrated claims and clinical data), transitions of care, and predictive risk models—that organizations can mix and match to identify populations ready for population health interventions.
• Increase efficiency, transparency, and flexibility. Non-SQL experts can customize and generate stratified patient lists, reducing the IT reporting burden, increasing effectiveness of care coordination, and providing clinicians with direct access to data.
• Build trust. Shareable, transparent logic provides actionable data to prepare identified populations for population health interventions.
• Avoid data silos and ineffective decision making. Data-informed decision making goes well beyond the capabilities of any single EHR—including comprehensive patient data from more than 300 sources in DOS and integrated claims and clinical data.

Use cases

• Clinical quality leadership reviews value-based contract performance and finds that a large percentage of the cost and utilization is due to comorbid patients, primarily from seven complex chronic conditions. After implementing the Pop Analyzer: Stratify, they can quickly identify and target the specific population based on predefined chronic condition populations for the care management team to enroll patients in a chronic care management program.
• A care management director needs to improve two problem areas identified in the contract performance report: high ED utilization and high readmission rate. After an initial review, they identify that many patients have out-of-network ED visits. Using the integrated claims and clinical data in Pop Analyzer: Stratify, they can quickly identify the right population and publish it for care managers to begin outreach.
• An analyst and clinician work together to define populations for care management programs and share insights with leadership. The analyst spends significant time repeating tasks like integrating population definitions and developing basic results. The clinician isn’t getting the information they need quickly enough—resulting in missed opportunities to share results and trending with leadership. With Pop Analyzer: Stratify, the analyst can immediately normalize commonly used populations and make them available for rapid use in the Care Management Suite. The clinician can also centrally define and govern population definitions.