Everyone will claim to have data analytics tools for population health management, but not all are created equal.
What if…You could find everyone with metabolic syndrome, or another chronic condition, that badly needs an intervention to avoid hospitalization with just a few simple mouse clicks? Or switch from high level population trend analysis to individual metrics or subsets of your choice to help your organization bend the healthcare cost curve? Access to this information is no pipe-dream, and can realistically be attained if you know where to look.
So, where are your hidden health-related cost centers? The same places they’ve always been: In plain sight. But for the lack of data transparency and integration of data tools and services, they remain elusive to spot. To uncover these cost centers, consider partnering with an analytics firm that not only can access data sets from everywhere patients access healthcare, but also combine them to create nuanced action lists.
Below are some questions that the right analytics partner can help you with right away:
Are medications costing you more than they should? Are your employees using non-formulary, compounded or specialty drugs when a cost-saving generic would have the same result? Step therapy and prior authorization can help, but will only get you so far. The data will reveal more “blind spots,” cataloging unique behaviors such as patients using multiple pharmacies.
Are your employees seeing too many specialists and PCPs? Some patients, the data will likely reveal, use multiple specialists and sometimes multiple primary care physicians – some in-network, some out. This can happen because a patient might split time between multiple locations or is a chronic-care employee. Coordinating care under a single PCP can reduce costs.
Can you identify preventable and/or non-emergent inpatient and emergency department use? Often, urgent care will provide similar, but less expensive outcomes as emergency care. Encouraging patients to use urgent care—and avoid the ER copay—can boost a health plan’s bottom line. But you must know more about ER utilization than you do now — to find out when ERs are being used inappropriately and predict when it might happen next.
Can you consult a table with drilldown ability to help you follow-up with all members that are biometric outliers, starting with those who are at the highest risk? Wellness programs, preventive medicine and case managers all can help these patient populations take better care of themselves, maintain their health and avoid ER visits, hospital admissions and readmissions. But it takes more than quick, occasional check-in phone calls.
And the list goes on…
All these questions, and more, can be answered with Poindexter, Advanced Plan for Health’s predictive modelling engine for population health management. Poindexter will transform your case management practice and your job satisfaction, giving you more time and flexibility to focus on your members and plan trends. Give us a call today to schedule a demo.