ABSTRACT
Risk scoring is used widely in healthcare for both financial and clinical applications. Risk stratification is quite different, in that it prioritizes the delivery of healthcare services to patients based on a quantitative score. Centers for Medicare and Medicaid Services uses a hierarchical condition category risk adjustment model to calculate risk adjustment factor (RAF) scores. Risk calculators use statistical regression analysis to compute the probability of an event such as admission, stroke, or death based on a weighting of risk factors. Based on the published findings, scoring tools can be deployed electronically via online calculators, apps, or built directly within the Electronic Health Record (EHR) system. The computation of the RAF score within the EHR utilizes a registry to identify the disease groups to which a patient belongs and the roll-up of the score. Registries identify the patient cohort as well as chronic disease comorbidities. Additional factors include age, medication use, utilization, mental illness, and substance abuse.
