Population Segmentation and Targeting of Health Care Resources: Findings from a Literature Review
Working Paper 58
Publisher: Washington, DC: Mathematica Policy Research
Dec 01, 2017
- Predictive analytics or quantitative claims data alone are not sufficient to inform segmentation or the timely tailoring of care to patient subgroups. The incorporation of clinical judgment, data from the electronic health record, health risk assessments, and interviews with patients requires time, but is vital to segmentation and the tailoring of health care resources to subgroups. Segmentation and efforts to tailor health care resources also need to consider the amenability of patients’ conditions to treatment and patients’ willingness to engage in recommended care or care management activities.
- Using an iterative process to segment HNHC patients into subgroups is important, both because organizations are constantly improving their segmentation approaches over time and because patient risk factors and health status change with time.
- Only a few of the articles reviewed noted how programs specifically tailor health care resources to each of the subgroups they identified. More typically, articles listed the general types of services available to patients deemed high risk, regardless of subgroup.
- Future work could examine the extent to which organizations find it feasible to create subgroup-specific care paths and resources versus simply using segmentation results to decide whether to assign patient subgroups to enhanced care management.