What is a Clinically Integrated Network? Before we start talking about Rising Risk programs, we should understand what Clinically Integrated Networks are and the challenges they face in increasing market share. A Clinically Integrated Network (CIN) is defined as a collection of
Why aren’t your PMPM numbers decreasing? It’s because your cost avoidance strategy is lacking
This blog post is part of our Real Customer Stories series which features lessons and case studies from actual VitreosHealth customers. Over the last few years, I have worked with many customers and prospects at VitreosHealth. There is one question
4 Reasons why Health Plans and Providers find it difficult to deliver proactive care
At a recent healthcare summit panel discussion in Oklahoma City, I was asked, “why aren’t health plans and providers not embracing proactive care management?” The question totally took me by surprise. The subtext of the question implied that the benefits
Which models will succeed in the race towards value-based care?
Over the last 8 years, I met many executives from a range of healthcare organizations – medical groups, Medicare and Medicaid HMOs, MSSP and Commercial ACOs, IDNs, and large hospital networks that are taking on risk contracts and actively transitioning
Predictonomics Part 2: Children’s Health
The availability of millions of patient records contained in different healthcare data sources such as claims, EMR (electronic medical records), self-reported surveys, along with consumer data on social determinants has made it possible to reveal interesting insights and predict future
Dear Jeff Bezos
Dear Jeff, Warren & Jamie: I recently met my ex-boss from PepsiCo for lunch. She was the vice president of Supply Chain before she took early retirement. After our initial family updates, her first question to me was, “What does
Is HMS Holdings following the Cisco strategy?
About 3 years ago, HMS would describe itself as a provider of cost containment services to government and private healthcare payers. HMS specialized in coordination of benefits services and revenue integrity solutions. Their main value propositions revolved around preventing future
Predictive Insights from a State of Mental Health Analysis of a Typical Exchange Population
At Vitreos, we know there is a lot of opportunity in reducing costs in multiple areas of healthcare spend. We have experience in identifying ‘Rising Risk’ members for avoidable emergent events for primary care, oncology-related post-chemo avoidable ER visits, and
Is Enterprise Analytics Software a Dying Delivery Model For AI-Based Predictive Insights?
I recently read the Harvard Business Review article To Survive, Health Care Data Providers Need to Stop Selling Data (read that here). Harsha Madannavar, Todd Clark, and Joseph Johnson, the authors of this article, claim: “Most data-driven healthcare IT (HCIT)
Predictonomics – Insights from Years of Experience in Healthcare Predictive Analytics
Remember the book Freakonomics? Authors Steven Levitt and Stephen Dubner chronicled very interesting insights revealed by microeconomic researchers; insights that macroeconomics would not necessarily identify. The book went on to be an international best-seller and was followed up by a
How do you measure the ROI of your population health AI-driven predictive models?
I want to illustrate my point by discussing the story of a CEO of a Medicare Advantage Plan with 10,000 members. This CEO is well known in the industry for his forward-thinking vision, capacity for risk-taking, and commitment to innovation.
The Top 4 Reasons Your Digital Member Engagement Solution Isn’t Working
At VitreosHealth, we launched our digital outreach solution in June of 2017. In that time, we’ve really learned what executives are looking for in a member engagement solution. Moreover, we’ve learned which attributes make a successful digital outreach program! Do
An Open Letter to Every Healthcare CEO
Dear Healthcare CEO, It is my belief that a strategic partnership with an AI-driven Predictive Analytics vendor can bridge the gap between your aspirations and results quickly. You are probably facing enormous uncertainty in the marketplace and feeling the
Payers are Hemorrhaging Money – Can Predictive Analytics Stop the Bleeding?
Oscar Health Insurance burst on the payer market in July 2013 and by April 2015 the company was valued at 1.5 billion dollars. However, in March of this year, Oscar revealed it lost over 100 million dollars last year.While the news
What Quality Measures Get Wrong – and How to Make Them Right
Healthcare is continuing its, somewhat painful, evolution from volume-based to value-based care. As it does, government programs, like Medicare, and private insurance companies increasingly use “quality measures” to evaluate a physician’s performance level. However, since everyone seems to have a
Where is your ACO in the Value-Based Care Maturity Model
Curious about how your ACO will do under Pathways to Success? So were our customers. The data scientists at VitreosHealth developed the Value-Based Care Maturity Model to answer that question. Take a look: This was an excerpt from a
Leveraging AI-driven ETL to Shed Light on the Healthcare Dark Data Problem
What is Dark Data? Gartner, the leading industry analysts, define dark data as the information organizations collect, process, and store during regular business activities, but generally fail to use for other purposes. According to IDC Health Insights, up to 90 percent of