Workflow GuideAllergy & Immunology

Risk Stratification for Allergy & Immunology Chronic Care

Optimize Allergy & Immunology patient outcomes with our chronic care risk stratification workflow. Learn to manage asthma, immunotherapy, and more.

Effective risk stratification is the cornerstone of high-quality Allergy and Immunology care. By systematically identifying high-risk asthma, immunotherapy, and primary immunodeficiency patients, practices can deploy targeted interventions, improve APCM enrollment, and prevent life-threatening exacerbations or anaphylactic events through proactive AI-driven outreach.

The Challenge

Many allergy practices struggle to identify which patients require intensive monitoring versus routine follow-ups. This leads to missed APCM billing opportunities, suboptimal asthma control, and high drop-out rates for long-term immunotherapy, impacting both patient safety and revenue.

Step-by-Step Workflow

1

Data Mining & Patient Identification

Utilize AI to scan EMR data for specific ICD-10 codes related to persistent asthma, primary immunodeficiency (PIDD), and chronic spontaneous urticaria to build a master chronic care list.

Best Practices
  • Focus on patients with two or more systemic steroid bursts in the last 12 months
  • Include patients on specialty biologics like Xolair or Nucala
Common Pitfalls
  • Overlooking patients who are stable on maintenance inhalers but qualify for APCM
  • Ignoring patients who have not had an office visit in over six months
2

Clinical Severity & Medication Adherence Assessment

Categorize patients based on medication complexity and adherence. Identify those requiring high-dose ICS/LABA combinations or those frequently refilling SABA rescue inhalers.

Best Practices
  • Cross-reference pharmacy refill data to identify non-adherent patients
  • Prioritize patients with a history of anaphylaxis or ER visits
Common Pitfalls
  • Relying solely on patient self-reporting for medication adherence
  • Failing to update the patient's asthma action plan during stratification
3

Immunotherapy Compliance Review

Stratify patients on Subcutaneous Immunotherapy (SCIT) or Sublingual Immunotherapy (SLIT) by their adherence to the maintenance schedule and history of local or systemic reactions.

Best Practices
  • Flag patients who have missed more than two consecutive maintenance doses
  • Automate AI reminders for patients entering the maintenance phase
Common Pitfalls
  • Treating all maintenance-phase patients as low risk regardless of reaction history
  • Failing to track home-based SLIT compliance
4

Social Determinants & Access Screening

Identify patients with socioeconomic barriers to accessing epinephrine auto-injectors or specialized IVIG treatments, as these factors significantly increase clinical risk.

Best Practices
  • Include zip code and insurance barrier data in the risk score
  • Ask AI agents to screen for financial barriers during routine check-ins
Common Pitfalls
  • Assuming clinical data alone dictates the risk of a flare or reaction
  • Neglecting to screen for environmental triggers in the patient's home
5

AI-Powered Outreach & Triage

Deploy automated AI voice agents to conduct monthly check-ins, assessing Asthma Control Test (ACT) scores or Urticaria Activity Scores (UAS7) to update risk levels in real-time.

Best Practices
  • Script AI to escalate red-flag symptoms like nocturnal cough to a nurse immediately
  • Use AI to confirm the patient has an unexpired epinephrine pen
Common Pitfalls
  • Relying on manual staff calls for the entire patient base
  • Failing to record AI-gathered data back into the EMR for APCM documentation
6

Care Plan Integration & APCM Billing

Map stratified patients into specific APCM care plans, ensuring all documentation meets AAAAI guidelines and CMS requirements for non-face-to-face care coordination.

Best Practices
  • Standardize templates for chronic urticaria and asthma care plans
  • Ensure 20 minutes of monthly clinical staff time is tracked for billing
Common Pitfalls
  • Failing to obtain patient consent for APCM enrollment
  • Incomplete documentation of the medical necessity for frequent monitoring

Expected Outcomes

1

Increased APCM revenue through systematic enrollment of eligible patients

2

Reduced asthma-related emergency department visits and hospitalizations

3

Higher retention rates for long-term immunotherapy and biologic patients

4

Improved patient adherence to asthma action plans and medication protocols

5

Enhanced practice efficiency by automating routine patient monitoring tasks

Frequently Asked Questions

AI automates the analysis of large datasets and conducts routine patient assessments via phone, identifying high-risk triggers and freeing staff for high-acuity clinical tasks.

Frequent use of rescue inhalers, history of intubation, multiple steroid bursts, and low ACT scores are primary indicators used in our stratification workflow.

Yes, by identifying and stratifying patients with two or more chronic conditions, you can accurately capture and document the time required for APCM reimbursement.

Yes, our AI solutions use encrypted, HIPAA-compliant protocols to ensure patient health information is protected during every interaction and data transfer.

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Risk Stratification for Allergy & Immunology Chronic Care | Tile Health