Guided Notes

Population Health & Risk Stratification

Registries, attribution, risk stratification tiers, rising-risk patients, social risk, care management targeting and measuring program impact.

What population health means

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Population health manages the health of a defined group — e.g. all patients attributed to an ACO, all diabetics in a clinic network, all members of a health plan. Key questions: • Who is in our population? (attribution) • Who is at highest risk? (stratification) • Who needs what intervention? (targeting) • Is it working? (evaluation)

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