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Influence on Lifestyle Change Does Have an Impact on Outcomes

Once populations are targeted for support and intervention via our Poindexter advanced and predictive analytics (via current state and predicted risk factors), we’ve found that one of the most effective ways to support targeted employees and members is through live or telephonic nurse influence and intervention.

Nurses are able to deliver individuals the education and support they need to make important lifestyle and preventative care changes. This is one of the most effective programs that we’ve seen in delivering needed outcomes.

Influence on Lifestyle Change Does Have an Impact on Outcomes
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Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization

With higher and higher ER bills coming in to the plan and members, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to their employees and members about which conditions can be handled by more convenient and lower cost sites of care such as a nurse advice line, telehealth (which often also covers behavioral health), on-site or retail clinic or urgent care. They’re also sharing details on how to reach these resources, and how much lower out-of-pocket costs will be to members who utilize them versus the ER. Keeping this information top of mind when it’s needed is the key to effective communications in this area.

Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization
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Keys to Truly Impactful and Measurable Employer Health & Wellness Programs

With medical costs rising, pharmaceutical costs quickly meeting or exceeding medical costs and miraculous specialty drugs coming in at nosebleed costs, optimizing employee health and saving for catastrophic events is paramount to afford expensive lifesaving medicines and treatments, along with inevitable catastrophic cases that plague nearly every employer’s health plan.

Keys to Truly Impactful and Measurable Employer Health & Wellness Programs
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Pre-Emptive and Analytics-Based Early Action Can Delay Kidney Dialysis, Reduce Plan Costs and Improve Quality of Life

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

Early intervention is the key to slowing or stopping chronic kidney disease (CKD), improving the quality of lives for those at risk and containing health plan costs. Avoiding dialysis for just one member represents a health plan savings of $350,000 to $700,00 per year, which more than pays for the CKD program by itself.

Pre-Emptive and Analytics-Based Early Action Can Delay Kidney Dialysis, Reduce Plan Costs and Improve Quality of Life
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What more do employer groups expect from their health plan or TPA?

In this busy selling season for TPAs and health plans, we wanted to share an updated eBook that outlines some of what the Advanced Plan for Health is hearing from our TPA, health plan and employer clients related to what employers are really looking for as they’re shopping for benefits.

Here’s an excerpt:

Providing your employer clients with the right mix of services and support boosts your chances of standing out and winning and retaining their business. Fortunately, most self-insured employers want the same thing: healthy employees, positive employee healthcare experiences and reduced costs. Sounds simple enough, but how can you be sure that you are offering the best solutions in today’s strained and ever-changing healthcare environment so that you can continue to differentiate yourself and show value?

What more do employer groups expect from their health plan or TPA?
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Combatting the Crisis in Drug-Resistant Infections and Treatment

Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health

A lot has happened since Alexander Fleming accidentally discovered Penicillin in 1928 after a chance exposure of staphylococcus to penicillin mold.  For his discovery, he won the Nobel Prize after penicillin was commercialized in 1945, used successfully for war wounds and surgery in World War II and hailed as the “miracle drug”. In his acceptance speech, Fleming admonished the world to beware that bacteria would become resistant in time.

Combatting the Crisis in Drug-Resistant Infections and Treatment
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Feature Engineering in Healthcare Analytics

Jason Rudy, Data Scientist / Programmer and Matt Lewis, Programmer / Product Manager

In a previous blog post, we walked through the process of building a predictive model using healthcare data. One of the things we touched on briefly there, was how important proper feature engineering can be to creating a useful representation of the underlying data, and how the choices made around shaping data into features can change the nature and performance of the resulting model. 

In this post, we’ll be going deeper into the process of feature engineering, and how to convert raw data inputs into a form that will make machine learning not only possible, but effective. 

Feature Engineering in Healthcare Analytics
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An APH Primer on Artificial intelligence and Machine Learning

Jason Rudy, Data Scientist / Programmer and Matt Lewis, Programmer / Product Manager

Fundamentally, machine learning is a set of techniques that allows the training of computer programs using example data. In the healthcare field, machine learning, coupled with large sources of patient / member data, can help generate predictions around population health, cost of care, events such as hospital admission and readmission, and give insight into the potential for individuals to experience specific outcomes and conditions (e.g. heart attacks, strokes, chronic kidney disease).

An APH Primer on Artificial intelligence and Machine Learning
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Taking the final mile with Population Health data findings - Nurse Navigation is one avenue

More and more frequently, our current and prospective employer group clients will ask us what we see as the most effective avenues to support employees and members who have been identified through analytics for outreach and support.

There are many avenues that our clients are taking to get individuals the education and support they need. Nurse Navigation is one of the most effective programs that we’re partnering with our clients to launch and manage. We thought this would be a good topic to cover during National Nurses Week.

Taking the final mile with Population Health data findings - Nurse Navigation is one avenue
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The Stars Impact of the CY2019 CMS Final Call Letter

Guest blog contributor:

Rex Wallace - Principal, Rex Wallace Consulting, LLC

On April 2nd, The Centers for Medicare and Medicaid Services (CMS) released the Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter. The entire document is a behemoth which includes important information about CY2019 for Medicare Advantage plans across a variety of topics. This paper will focus solely on the impact on Star Ratings.

The release of the Final Call Letter is one of a series of key milestone dates leading up to October 11, 2018, when CMS releases Star Ratings for each Medicare Advantage organization to the public.

The Stars Impact of the CY2019 CMS Final Call Letter
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