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Insights Population Analytics and Risk Stratification Tool

The Integrated Population Analytics (IPA) tool uses the Johns Hopkins ACG algorithms to provide effective risk stratification and population health analytics to our customers. It supports health and care systems to understand their population needs and activity drivers using risk stratification algorithms.

 The IPA tool provides:

  • A modular, flexible Integrated Population Analytics Tool, supported by our Data Management Services
  • Standard reports at CCG or locality level
  • Customised reports for specific services, tailored to your requirements
  • Information governance requirements are minimised as it is located in the SCWdata warehouse
  • Implementation and roll-out support, including training, is provided
  • We also work with partners where this provides the best fit with customer requirements.


The tool has been designed with primary care clinicians and teams in mind, as vital stakeholders for population health: 

  • We have worked with primary care clinicians to design the user interface and requirements. This ensures that the information is intuitively relevant to GPs and primary care teams. Intuitiveness is supported with minimal “clicks” to get to patient information and an appealing visual presentation 
  • The IPA tool includes the Electronic Frailty Index and a mortality predictor. Flexibility can be extended to add further case-finding tools and algorithms 
  • There are a range of data quality reports that provide added benefits to practices,
  • Ease of use is a priority. Automated extraction of primary care information supports this. 
  • The IPA approach builds on the existing data flows from secondary care that is already used for planning and performance management. Using this approach ensures consistency of analysis and builds on the in-depth knowledge and understanding of our analytics teams. Costs of additional data management are minimised providing a cost-effective service.
  • Our expert team will support you with setting up data-sharing agreements across GPs and relevant partners. We provide full support for the operational side of the service. Our analytics teams work with you to understand current and future requirements, providing the evidence you need to develop new models of care.

For more information on our Insights population analytics please contact SCW Head of Population Health Management, This email address is being protected from spambots. You need JavaScript enabled to view it. or email us at This email address is being protected from spambots. You need JavaScript enabled to view it..

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