Risk Stratification…What You Don’t Know Will Hurt You

The care management team is perhaps one of the largest sources of investment for ACOs or any other organization transitioning to a value-based payment model.  Therefore, it is critical that an organization use every piece of data available to guide the care team in identifying high-risk, high-cost patients to effectively manage the population as a whole. Only then does achieving improved outcomes and lower costs by avoiding hospitalizations and ER visits become a reality.

With the various electronic health records (EHRs), clinical decision support (CDS) systems and population health management solutions available, organizations can capture data which may include lab results, imaging results, medication lists, claims data, procedure codes, vitals and so forth to assist with assignments of patient risk categories. However, with all of these advances, there is one area of potential risk that is not being factored into the analysis: genetics.

Our healthcare system has long operated under a “one size fits all” approach that is a result of well-designed clinical trial results and the concept of evidence-based medicine. However, it is not often acknowledged that these clinical trials have limitations such as the fact that they only last a year or so and that they only enroll the healthiest of patients. In reality, this “one size fits all” approach just doesn’t work.

This is especially true when we talk about medications: two people just don’t respond to the same medication in the same way. This may be due to the genetic variations that can affect response to medications, which can ultimately lead to treatment failures and adverse events…and of course, the associated increased costs. It’s hard to imagine that these less than ideal responses to medications may have been avoided by a simple dose adjustment or using a different medication altogether.

Risk assessment, or risk stratification, of patients plays a critical role in determining success in a system that is moving toward rewarding organizations for keeping cost down and improving outcomes. We know that medications play a critical role in the treatment of disease and strongly influence better outcomes. However, we also know that we need to improve medication use in the United States. Some of the staggering facts we need to face are:

  • In 2015, approvals of new drugs hit a 19-year high.
  • Adverse drug events (ADEs) are the 4th leading cause of death in the United States.
  • In hospitalized patients, ADEs cause 1 out of 5 injuries or deaths per year.
  • 75% of people have variations in at least one drug metabolizing enzyme and do not metabolize medications normally, increasing their risk for ADEs.
  • The FDA now recognizes over 100 medications that have drug-gene interactions, yet we do not routinely screen for these interactions.

It has been established that incorporating genetic factors into the prescribing process can help improve treatment outcomes and reduce ADEs. It is also understood that testing all patients is impractical and would present a financial barrier. YouScript addresses this concern as well.

With the technology of the YouScript solution and a single data extraction, we can identify which patients of your entire population are at the highest risk for an ADE and predict how much money you’d save by testing their genetics.

This modeling is based on the recent results from a pharmacogenetic-focused clinical trial at the University of Utah that was recently published in the Journal of Medical Economics. It showed that the pharmacogenetic-tested cohort experienced a decline of 39% in hospitalizations and 71% of ER visits compared to a matched control.

YouScript is the only solution available that can help address these drug-gene interactions and perhaps more importantly, cumulative interactions, defined as interactions caused by three or more drugs/genes. These gene-based and cumulative interactions make up 37% of the most severe drug interactions that are completely missed by other interaction programs. This information is not currently being factored into the risk stratification process, but it should be.

We are confident that you will find the genetic risk analysis of your organization a “no-regrets” investment.  As proof of our sincerity, we are offering a free risk stratification for up to 5,000 of your patients. This stratification will also include a cost-savings estimate based on current data from your organization.  We trust you will find it an illuminating review. [Sign up now!]

To learn more about our Genetic Risk Analysis tool click here.