Jay Prystowsky, MD, MBA, director of medicine and surgery services for Sg2, recently identified the importance of patient segmentation in effective care coordination:
Patient segmentation will be needed to identify those patients who will benefit the most from care coordination and chronic disease services…Whatever the method used, the goal is to find the patients most at risk of decompensation and exacerbations of their conditions. These patients should be the focus of care management efforts, to improve their quality of life and functionality, and to decrease avoidable utilization of health care services.
Dr. Pystowsky suggests segmentation will help maximize the value of the new programs and policies, which encourage providers to define or refine their care management programs and processes, enacted by CMS. He further adds, “Chronic care management (CCM) has become essential and increasingly critical to success.”