Revisiting conclusions on the empiric segmentation of high-risk patients

Michaud V, Dow P, Turgeon J

Published June 10, 2022

Abstract

We would like to comment on the article “Empiric Segmentation of High-risk Patients: A Structured Literature Review” by Arnold et al published in the February 2022 issue of The American Journal of Managed Care^® (AJMC^®).¹ The financial burden of health care pushes clinicians, health plans, and policy makers to achieve better outcomes at lower costs. We agree with the authors that health care systems have successful processes to identify patients with high utilization/costs and the highest risk of poor outcomes. The challenge remains to identify patients with high cost and at high risk for whom actionable interventions will sustainably reduce costs and improve outcomes. Although we agree with several points made by the authors, we want to provide feedback on generalizations made regarding interventions for high-risk populations.