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Clinical intuition linked to more care management in high-risk patients

Compared with other methods to identify high-risk patients for care management, practices within the Comprehensive Primary Care initiative that primarily used clinical intuition provided care management to the highest proportion of these patients, according to data published in Annals of Family Medicine.

“Primary care practices are using several tools to define high-risk patients at the point-of-care for the purposes of proactive care management,” Ashok Reddy, MD, MS, from the Center for Medicare and Medicaid Innovation, Baltimore, told Healio Family Medicine. “As [primary care physicians] and practices start to have more resources for risk-stratified care management through new primary care models, it is important to reliably link these services to the highest risk patients. This requires structural changes at the practice-level to look at populations they care for and accurately define these high-risk patients.”

Researchers sought to determine risk stratification patterns and association with care management services for primary care practices in the Comprehensive Primary Care (CPC) initiative. Using a qualitative approach, they categorized risk stratification methods used by CPC practices, and then tested whether these methods were connected to delivery of care management services.

In total, CPC practices reported using four primary methods to stratify risk for their patient populations. Analysis showed that 215 practices used a practice-developed algorithm, 155 used the American Academy of Family Physicians’ clinical algorithm, 62 used payer claims and electronic health records, and 52 used clinical intuition.

Although the CPC practices that used practice-developed algorithms detected the most number of high-risk patients per PCP (n = 282; P = .006), practices that used clinical intuition had the most high-risk patients in care management (n = 91; P = .036) and a higher proportion of high-risk patients receiving care management per PCP (48%; P = .128).

“PCPs should look at the needs of their patients. If these patients need extra support — linking patients to behavioral health, self-management support, help with transition from ED visits or hospitalizations — PCPs should talk to them about the support that the practice can provide for care management,” Reddy said. “It appears that combining clinical intuition with an algorithmic approach to risk stratification may work best.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.