Which is a common risk stratification model?

• A. Glasgow Coma Scale
• B. Karnofsky Score
• C. Hierarchical Condition Categories (ICD-10)
• D. APGAR Score

Answer: (C)

Risk stratification in healthcare uses models that translate a patient’s conditions into a single risk score for future costs and utilization. Hierarchical Condition Categories map ICD-10-CM diagnoses into condition groups with weights, and the hierarchy prevents double-counting by giving priority to more severe conditions. This approach is widely used in Medicare Advantage and other payer risk adjustment to predict future costs and guide resource allocation. The other tools assess current clinical status rather than future risk: Glasgow Coma Scale measures consciousness level after injury or illness; Karnofsky Score evaluates a cancer patient’s functional ability; APGAR Score assesses a newborn’s health right after birth. So, the Hierarchical Condition Categories (ICD-10) stands out as the common risk stratification model.