Reason for Evolution
Reason for Evolution
Most organizations are in the phase of identifying patients through clinical or financial risk profiles. Increasingly, what has become apparent is the need to further hone that process to be much more precise so that you can appropriately identify where you can have the greatest impact with available resources. So, the question becomes, what other information is needed, beyond the individual’s clinical or financial risk profile to be able to determine the greatest areas of leverage for impacting medical trend. Similarly, the question needs to be asked, what’s going to be the most effective route for engaging with the individual in addressing the problem, a gap in care for example. We think this particular area offers real opportunity to get to the next level.
It’s the application of novel predictive analytics to the combination of clinical, financial, and economic behavior data that helps SCIO identity the specific population segment and targetsthose individuals within that segment that we can optimize for medical trend improvement and optimal clinical outcome.
A Comprehensive Approach
This approach goes beyond just knowing that a person has a chronic condition and that, theperson is someone who has been identified as being a “high risk.” It helps answer the questions, what are the opportunity points? What are the gaps that specifically will generate the greatest value back to the individual and to the plan or the risk bearer in terms of taking action?From that, I will know exactly where I can focus my attention. I can begin to look at what we would refer to as high and low value services. Things that I might spend money on but really aren’t going to make a difference in helping to close that gap or get this person to the next level of health and wellness and in turn generate cost savings to the plan and medical trend improvement overall.
Different from the Past
We are partnering with a patient or member profile with consumer behavior information, and performing detailed analysis of the underlying utilization patterns and behaviors by types of service and provider. Increasingly organizations are faced with decisions about where to allocate resources–we provide better information to inform decisions on where to place your resource bets– focus more on approaches you know can have a quantifiable and achievable impact or continue to try a variety of approaches to see what might work. It comes down to increasing precision in decision making.
"Patients are increasingly responsible for their financial healthcare decisions and want to make sure they are working with the most efficient providers and that they are working with a health plan that is vested in their outcomes as well"
We work with care and wellness companies that are doing outreach in Medicaid populations. We provide a very specific list of individuals that have an intervenable risk profile. We highlight what intervention is necessary because we have profiled the utilization trends determining what areas yield the greatest impartibility score. A patient profile is created and we provide details to our partner who in turn knows who to outreach to and how to outreach to them creating both a higher level of engagement but also activation within the target population.
Providers are taking risks. They need to understand more about the population because they typically have more finite resources than perhaps a payor would traditionally, so they need to really make sure they are focusing in on the right patients that will have the greatest possible benefit from their intervention.
Payors have to be able to manage the medical trends. Better information will help them focus on the high value target areas, refining program approaches, and partnering with providers.
Patients are increasingly responsible for their financial healthcare decisions and want to make sure they are working with the most efficient providers and that they are working with a health plan that is vested in their outcomes as well.
The bottom line is resources are very limited and very precious. You want to be strategic and spend resources that will garner the best results and generate the highest quality experience for everybody involved.