Most risk stratification models predict cost and utilization based on current patterns, but what about patients who fall through the cracks? This session explores how the California Department of Health Care Services (DHCS) utilizes the Risk Stratification, Segmentation and Tiering (RSST) algorithm to identify high risk Medi-Cal members consistently and transparently across California, including individuals with unseen risks. These include those who sporadically touch the system and return with serious conditions—ensuring that barriers to access don’t mask high-need populations.
