Population Segmentation: An Environmental Scan and Qualitative Analysis of Promising Approaches

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Health care delivery organizations are seeking guidance for identifying their high‐need patients. Some organizations segment their entire patient population into risk categories, with some further segmenting their high‐need patient group to better capture its heterogeneity and target resources more effectively. Not only is segmentation a key to maximizing the resources available to improve care for high‐need, high‐cost patients, it is also critically important to health systems taking part in “advanced” alternative payment models that require the sharing of major financial risk as well as responsibility for quality and outcomes. Although the science is still young, a study of segmentation and resource‐targeting strategies from the field can offer needed direction to health systems and providers. Mathematica Policy Research will conduct a scan of segmentation approaches that go beyond the risk stratification that health systems use to separate high‐need, high‐cost patients into subgroups with common care needs. The team will start with an extensive review of the literature, building on The Commonwealth Fund’s efforts to understand segmentation approaches. They will then conduct interviews with 50 leaders and staff at health care organizations employing a range of segmentation strategies. The organizational screening process will ensure a wide net is cast, and national experts will provide input on the final selection. Interviews will explore methods used to stratify the entire patient population, with a special focus on segmenting and targeting resources to the high‐need, high‐cost group. By learning from real‐world examples of population segmentation, this project will help health care systems, including newer accountable care organizations, large multispecialty groups facing down‐side financial risk, and practice networks, overcome the challenges they face in providing effective and efficient care to their high‐risk patients.

Grant Details

Grantee Organization:
Mathematica Policy Research, Inc.
Principal Investigator:
Ann O'Malley, M.D., M.P.H.
Award Amount:
$314,593.00
Approval Date:
November 8, 2016

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