? Clinical Risk Grouping Solutions – Smarter Risk Stratification for Better Healthcare Outcomes

Clinical Risk Grouping Solutions (CRGs) are tools used by healthcare providers, payers, and public health agencies to analyze, stratify, and manage patient populations based on their clinical risk profiles. These solutions support more personalized, efficient, and cost-effective care.

? What CRGs Do:

• Group patients into clinically meaningful categories based on diagnosis, treatment history, comorbidities, and care patterns

• Predict future healthcare utilization, costs, and potential outcomes

• Support value-based care, resource planning, and case management

• Enable population health management by identifying high-risk groups

? Key Features:

• AI/ML-powered analytics for accurate risk scoring

• Integration with EHRs and claims data

• Customizable models for different payer/provider needs

• Visual dashboards for real-time insights

? Market Drivers:

• Shift to value-based reimbursement models

• Rising healthcare costs demanding better risk management

• Increasing demand for data-driven clinical decision-making

• Growth in healthcare analytics platforms and AI adoption

? Who Uses It:

• Payers – for risk adjustment and premium setting

• Providers – to target care coordination and reduce readmissions

• Health Systems – for strategic planning and care optimization

• Government agencies – for public health surveillance and policy