Reflections from the NHS in England.

This paper describes the approach taken to "high-risk patients" in England. It provides an overview of the use of risk stratification to identify those at high risk and policy innovations designed to provide preventive care, including the community matron and virtual ward initiatives. We review how such initiatives have been evaluated and discuss the findings of those evaluations. We conclude with a discussion of next steps for the use of risk stratification, such as honing the focus to identify those individuals most likely to respond to preventive care, and we sound a cautionary note in favour of realistic expectations regarding the use of risk stratification and the emergence of anticipated benefits.