Creating Cohorts Using KYN Risk Triggers

inHealth recently worked with Conifer to create custom risk triggers to allow for easy reporting and member identification. These 2 new custom triggers can be found in the Conifer Risk Stratification tool for all inHealth clients.

The 2 KYN Custom Risk Triggers are titled:

• KYN 0-79 (Low Risk)
• KYN 80-900 (High Risk)

The below instructions show how you can use the Risk Stratification to pull all cohorts.  From the results once you run you report you can:

• Create lists
• Create Wellness/PHM/Other episodes
• Export to excel
• Create mail merges to assist with mailings to specific cohort (or other) group

Step by Step Process

1. Go to Population Health menu bar, then click on Risk Stratification
2. Click on Show More
3. You are then able to filter by Cohort group by:
   1. Risk Strat Level
   2. Risk Strat Triggers, including custom KYN Risk Triggers

1. 1. ---

Example 1: Cohort Priority risk claims

1. Click on Priority Risk Strat Level to sort by Priority
2. Then click on Risk Strat Summary
3. Click on QX-YEAR Elig Scrnd
4. You will then see your Priority members by category:
   • (“Participants”-TOTAL priority members)
   • Scrnd Part. (“Previously Screened Participants”-Priority members who have been screened in the last 12 months.) “Screened” is typically having an open Utilization Review, Wellness, or Personal Health Management episode of service, but can vary by client.
   • To be Scrnd Part. (“Eligible to be Screened Participant”-Priority members who have either been assigned a new trigger that moved them into the Priority Stratification level OR have not had any recent screenings within the last 12 months.) “Recent screenings” is typically having an open Utilization Review, Wellness, or Personal Health Management episode of service, but can vary by client.
5. From there you can mass create episodes (and can choose the # to be assigned), OR you can click on a number hyperlink to review all Priority members. (In this example, all have been screened so you would not assign as there are not any members who are eligible to be screened.)
   
6. From here you can create a list or copy a list of members into an excel file if needed (not recommended as lists and criteria can be shared among users)
   
7. In addition to mass assigning episodes, you can assign episodes through individual members by using the drop-down box and going to MMOTS.

Example 2: Cohort High risk claims + biometric high risk (KYN RTS>80)

1. Choose No known risk-KYN 80-900 (High Risk) under the Strat Triggers filter in Risk Stratification
   
2. Click on Risk Strat Summary
3. Click on QX-YEAR Elig Scrnd
4. From here you will see High Risk Strat members WITH a biometric high risk (KYN >80.) In this example, there are a total of 197 members who fit this criterion. 33 of these members are eligible to be screened.

Example 3: Cohort No claims in prior 12 months, biometric low-mod risk (KYN RTS<80)

1. This cohort is using two Risk Triggers so a list will need be created.
2. Choose Strat Trigger: No known risk-Claims Utilization-No RX and No Medical data in prior 12 months
   
3. Click on Risk Strat Summary
4. Click on QX-YEAR Elig Scrnd
5. Click on the Total Unique Participants
   
6. Scroll down to the bottom, name your list, and click on Create List
   
7. Leave Risk Stratification application—it might take a minute or so to download the list to the system.
8. Go back in Risk Stratification and click on Show More
   
9. Choose Risk Strat Trigger: No known risk – KYN 0-79 (Low Risk) (CUSTOM)
   
10. Expand Participant Details
    
11. Under Only Participants in List, use the Lists Within List drop-down and choose the list you just created
    
12. Click on Risk Strat Summary
13. Click on QX-YEAR Elig Scrnd
14. From here you will see members with no claims in prior 12 months WITH a biometric low risk (KYN <80.) In this example, there are a total of 277 members who fit this criterion. 259 of these members are eligible to be screened.
    

 

Cohort Reporting for Specific Plan Year

1. Run a General Statistics Report for completed screenings for dates you are looking for:
   1. Group:  Choose your Group
   2. Employer:  Choose employer if appropriate
   3. Service Type:  HRA
   4. Must be Open in Period:  beginning of specific plan year-today’s date
   5. Sort By:  Group (or anything for these purposes)
   6. Click on General Statistics
      
   7. Click on the Total EOS’s
   8. Scroll down to the bottom, title your list and click on Create List
2. You can then pull this list in prior to running your report through Risk Stratification
3. If you are using another list within Risk Stratification (such as Example 3 in the instructions—(No claims in prior 12 months, biometric low-mod risk (KYN RTS<80) with only in PY 2, you will need to combine lists.  So, for Example 3 in the instructions, you would add the following steps once you have created the list above:
   1. Choose Strat Trigger: No known risk-Claims Utilization-No RX and Mo Medical data in prior 12 months
   2. Click on Risk Strat Summary
   3. Click on QX-YEAR Elig Scrnd
   4. Click on Total Unique Participants
   5. Scroll down to the bottom, name your list, and click on Create List
   6. Leave Risk Stratification application
   7. Go to Date Management > User List Management (it can take a few seconds for the list to appear, so refresh screen if you do not see your new list yet)
   8. Click on the 2 lists you have now created
      
   9. Scroll down to the bottom and click on Create List from Selected
   10. New Listname:  Name your list and then click on Create Overlap List
   11. You will then see your new list which will only include those members who are in both lists.
       
   12. From there you will continue with your report.  Go back in Risk Stratification and click on Show More
   13. Choose Risk Strat Trigger:  No Known Risk-KYN 0-79 (Low Risk)
   14. Expand Participant Details
   15. Under Only Participants in List, use the Overlap list you created
   16. Click on Risk Strat Summary
   17. Click on QX-YEAR Elig Scrnd
   18. From here you will see members with no claims in prior 12 months WITH a biometric low risk (KYN<80.)

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