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).
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.
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.
All entities managing health plans – self-insured employers, health plans, brokers and more – need to take note of the impact of diabetes on the health of their members and the financial bottom line of their health plans. Particular focus needs to be put on the recent changes to care guidelines for diabetic control as they aim to improve diabetic care – but differ – which is causing confusion.
Mental and substance abuse disorders and their downstream impacts are becoming a growing concern for employers – with costs to employers estimated at $225.8 billion each year. Notably, the financial impact goes beyond absenteeism to include presenteeism as well. Presenteeism, or individuals working with untreated illnesses, is estimated to cost employers $1,601 per person each year according to the same Inc. Magazine article.
Many employers are actively looking for better ways to offer their employees support in this area – as they do for overall wellness and chronic conditions such as diabetes and high blood pressure.
Several of our Health Plan clients and their members have experienced unexpected and very unpleasant surprises following certain complex surgical procedures – usually spine-related. So we wanted to get a cautionary word out a bit more broadly on this topic to our clients and others who may be facing similar situations. The surprises are coming in the way of bills for intraoperative neurologic monitoring (IONM).
In one case, the billing technician was not a physician, and the member’s bill for monitoring services was an unreasonable, non-negotiable $120,000.
The team at Advanced Plan for Health (APH) is passionate about improving the health and well-being of as many healthcare consumers as possible, so in honor of Heart Health Month, we created a Consumer Guide to High Blood Pressure for you to use to share details on the risk of hypertension and some preventative measures with your member, employee and patient populations. We encourage you to share any of this information as you find appropriate.
Employers have found that it is not only the catastrophic conditions inherent in the high risk employee cohort, but also individuals who have reached the high risk group as a result of many different health issues (co-morbidities), lacking a personal physician, and inappropriately using the hospital or emergent care services for preventable problems. Plan members who are bouncing from one physician to another, because they may not understand what they need or where to obtain the requisite services, also present opportunities to improve clinical and financial metrics.
Most company resolutions come in the form of strategies and goals that become the focus for the year ahead. They include wellness programs for employees, benefit changes that will hopefully inspire amendment to employee behavior and “better pricing” from providers and networks.
Congratulations to our partner/client, Hill Country Memorial—located in Fredericks, Texas—for emerging as a recipient of the 2014 Malcolm Baldridge National Quality Award, our nation’s highest Presidential honor for performance excellence through innovation, improvement and visionary leadership.