Understanding risk stratification
The goal of a well-functioning healthcare system is to uplift the health and well-being of the population with high-quality, timely care while keeping costs low. Healthcare providers are measured on their ability to do this by the Centers for Medicare and Medicaid Services (CMS) using a variety of metrics. The performance of healthcare providers against these metrics is an important factor in how they are reimbursed for the services they provide.
As part of the value-based care model, CMS introduced programs that reimbursed providers based on the value of care they provide to their patients. The traditional model, known as fee-for-service, incentivized providers in terms of the number of services they provided, such as the number of procedures they performed or the number of tests they ordered. This increased the overall cost of care without noticing a lot of improvements in the general health of the population. In the value-based care model, providers...
