Common use of Risk Stratification Clause in Contracts

Risk Stratification. Contractor will use an approved health risk stratification mechanism or algorithm to identify new Enrollees with high risk and more complex health care needs. The health risk stratification shall be conducted in accordance applicable DPL(s) as indicated in Section 2.1.5. 2.8.1.1. Contractor shall use the following data sources to identify an Enrollees’ risk level. 2.8.1.1.1. Medicare utilization data, including Medicare Parts A, B, and D. 2.8.1.1.2. Medi-Cal utilization data, including IHSS, MSSP, SNF, and Behavioral Health pharmacy data. 2.8.1.1.3. Results of previously administered assessments. 2.8.1.1.4. Other population- and individual-based tools.

Risk Stratification. Contractor will use an approved health risk stratification mechanism or algorithm to identify new Enrollees with high risk and more complex health care needs. The health risk stratification shall be conducted in accordance applicable DPL(s) as indicated in Section 2.1.5. 2.8.1.1. Contractor shall use the following data sources to identify an Enrollees’ risk level. 2.8.1.1.1. Medicare utilization data, including Medicare Parts A, B, and D. 2.8.1.1.2. Medi-Cal utilization data, including IHSS, MSSP, SNF, and Behavioral Health pharmacy data. 2.8.1.1.3. Results of previously administered assessments. 2.8.1.1.4. Other population- and individual-based tools.