Chris Galanos, Director of Medical Services, Advanced Plan for Health
Our customers and partners rely on us to keep our finger on the pulse of what’s coming in the marketplace, and what we’re seeing trend within the member population in our Poindexter advanced and predictive analytics platform.
I recently performed a market scan and Poindexter information synthesis in support of providing a read-out on 2019 Medical Cost trend predictions, and felt it would be helpful to share a summary via the APH blog.
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.
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.
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.
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.
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?
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.