The Risk Classification section is one of the final clinical components of Care Plan 2.0 and provides an overall assessment of the patient's health risk. It enables care coordinators to classify patients based on the complexity of their medical conditions, behavioral health, functional status, social determinants of health (SDOH), and other clinical findings documented throughout the Care Plan.

Rather than functioning as a standalone assessment, the Risk Classification summarizes information collected across multiple sections of the Care Plan to help prioritize patients, guide interventions, and support ongoing care management.

Risk Classification helps care teams:

The assigned risk level should reflect the patient's overall clinical picture rather than a single diagnosis or vital sign.

Before completing Risk Classification, ensure the following sections have been completed:

Completing these sections first provides the information necessary to accurately determine the patient's risk level.

Risk Classification represents the patient's overall level of clinical complexity and likelihood of requiring additional care coordination. It considers multiple aspects of the patient's health, including:

The resulting classification helps care teams determine how aggressively the patient should be monitored and supported.

Although each organization may have slightly different clinical workflows, the following factors commonly contribute to the patient's overall risk.

Patients with multiple chronic diseases generally require more frequent monitoring than patients with a single stable condition. Examples include:

Recent healthcare utilization may indicate worsening disease or inadequate disease management. Examples include:

Patients taking numerous medications or medications requiring close monitoring may present additional clinical risks. Examples include:

Behavioral health conditions can significantly affect treatment adherence. Examples include:

Functional limitations affect the patient's ability to independently manage chronic conditions.

Examples include:

SDOH can increase patient risk even when clinical conditions appear stable. Examples include:

Patients who actively participate in their care often experience better outcomes than patients who struggle with treatment adherence. Consider factors such as:

Depending on your organization's workflow, patients are generally classified into one of three categories.

Low-risk patients typically have:

A patient with well-controlled hypertension who regularly submits RPM readings and attends scheduled appointments.

Moderate-risk patients may have:

A patient with diabetes and hypertension who occasionally misses follow-up appointments and requires additional education regarding medication management.

High-risk patients generally require intensive care coordination. Characteristics may include:

A patient with congestive heart failure, diabetes, COPD, food insecurity, and multiple hospital admissions within the past six months.

Documenting the reasoning behind the assigned risk level improves continuity of care and assists future care coordinators during subsequent reviews.

Risk Classification should not remain static. Care coordinators should reassess the patient's risk whenever there is a significant change in:

Risk levels should also be reviewed during each scheduled Care Plan evaluation.

Risk Classification influences many aspects of the patient's care plan. Examples include:

Higher-risk patients may require:

Risk level helps determine:

Patients with higher risk may require:

High-risk patients may benefit from earlier physician review and closer multidisciplinary collaboration.

A patient who previously required weekly outreach has achieved blood pressure control, consistently completes self-management tasks, and has had no recent hospitalizations.

Action: Reassess the patient's risk level and update the Care Plan if appropriate.

A patient with previously stable diabetes is hospitalized for heart failure exacerbation.

Action: Review the patient's overall condition, update interventions, and consider increasing the patient's risk classification.

A patient loses transportation to medical appointments and reports difficulty obtaining medications.

Action: Update the SDOH section, revise interventions, and reassess the patient's overall risk.

Review recent assessments, RPM data, medication changes, hospitalizations, and SDOH information. Update the Risk Classification and supporting documentation as needed.

Yes. Risk Classification is intended to evolve as the patient's clinical condition and circumstances change.

Yes. Every Care Plan should include an appropriate risk classification to support prioritization and individualized care planning.

Depending on your organization's implementation, some information may be presented to assist with the assessment. However, care coordinators should review the complete clinical picture and assign the most appropriate risk level based on professional judgment.