Predictive analytics for the healthcare industry continues to be big news. At this year’s HIMSS conference, there were over 40 breakout sessions solely dedicated to the topic and it seems everyone wants to jump on the health analytics bandwagon – – even IBM is getting into the game.
However, there are proven healthcare payer solutions that can help organizations save money while improving service; and attendees at HIMSS16 – and CEOs and COOs at insurance companies across the country – are missing them.
The code to lower costs and better service has been cracked, and a regional payer in Oklahoma has the answers.
For more than two years GlobalHealth has been using a predictive and prescriptive analytics program to positively change the lives of its members.
“We can now predict 70 percent of our hospital admissions,” said Scott Vaughn, CEO of GlobalHealth. “That gives us a huge opportunity to reach out in a very focused way to the people who need our services the most.”
This thoughtful approach to improving their member’s health has substantially benefited both GlobalHealth and its members.
“We have had a 10 times return on our investment and the value we’ve gotten out of it in terms of reduced healthcare costs,” said Vaughn. “This year, we have an initiative in place where we plan to reduce healthcare costs by 10 percent.
That would be about 25 million dollars in savings that we can then pass on to the members, use to improve healthcare benefits, or reinvest to help us deliver better service.”
As a regional payer, GlobalHealth didn’t want to massively overhaul its existing IT or organizational structure to start an analytics program. According to Vaughn, there were four key factors that helped his company realize these impressive results.
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Data Isn’t Everything
It may seem counterintuitive, but data alone isn’t the most important aspect of a clinical risk management program. The key is to understand how to turn that data into actionable outcomes that directly impact members.
“We partnered with a company called VitreosHealth,” said Vaughn. “Most health plans look at the members who have generated the most costs historically and focus on them. Whereas VitreosHealth, they look at those members as well, but they also identify members who haven’t generated high costs in the last 12 months but are very likely to have serious health complications in the near future.”
“We call that ‘insights as a service,’” said Jay Reddy, president and CEO of VitreosHealth. “We sort through the data, say this is what it means, and these are the actions you can take to see results.”
With VitreosHealth’s assistance, GlobalHealth reaches its members and helps prevent major health issues from occurring.
“They take our data in any format and give us back actionable information,” said Vaughn. “For example, there are indications a diabetic patient’s glucose monitor might not be working properly, or that a patient’s prescription fill rate suggests he or she may not be taking medication as needed. They aren’t just sending us reports. We know, if we complete these very specific tasks, we will see results.”
A great deal of consideration went into selecting GlobalHealth’s analytics partner, but, according to Vaughn, that was just the first step. How a payer incorporates the solution is just as important.
“Integrating the VitreosHealth solution was easy,” said Vaughn. “However, when we started trying to execute on it, we first used our existing case management staff and weren’t getting the kind of traction that we needed. Our solution was to create a separate unit dedicated to member outreach and once we did that we started seeing significantly higher level of success.”
“GlobalHealth found the key to integration,” said Reddy. “If you go to the current case management team and say, ‘This is what you need to do,’ they tend to view it as an incremental shift in operations. But this is not incremental.
“This is a transformational proactive care management approach. As a part of that transformation, the first thing you do is break the program out and treat it like a separate operating initiative. This allows you to perfect the system. Then, once you know it’s succeeding, you can seamlessly integrate with the rest of the operations within the organizations.”
Effective, Thoughtful Outreach
There’s a perception clinical risk assessment programs are impersonal. However, when thoughtfully executed, exactly the opposite is true. These programs can affect the health of individuals in a very personal and impactful way.
“Originally there was some hesitation from our members, and we had to learn how to tailor our approach,” said Vaughn. “It’s all how we interact with our members so they understand that we’re there to help them navigate this complex healthcare system.
“We give a lot of flexibility to our staff to do what needs to be done to close the care gap. Maybe it could be something as simple as the member’s car is in the shop and they can’t get to their doctor. So we’ll send out an Uber to out the member and to take them to their doctor’s apt. It’s much more than just sending out a letter, and it’s much more than even just a phone call. It’s having a focused program that’s driven based on the data that VitreosHealth is giving us.
Open, Honest Communication
Finally, when selecting a healthcare information technology provider, know you are entering into a partnership. Your organization needs to be open and as communicative as possible.
“Any organization that’s going through this transformation needs a trusted vendor that they can open up to and say this is our vision, these are our goals, how can you help us?” said Reddy. “Very early on, GlobalHealth told us their exact goals for risk management and healthcare. And we want that, because once we know what the organization’s goals are, then we can determine what we as a partner can do to help them.”
“It’s been a real partnership from the start in a couple of different ways,” said Vaughn. “First, VitreosHealth is very much integrated into our business. Second, they truly want to make a difference, and they know that if we’re successful then they’re going to be successful. They’re not just sending us reports. They are actively involved in helping us execute and achieve success. And that success in measured in improved health outcomes, lower cost, and better service.”