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Insights from GNS Healthcare

Care Management Analytics Wasting Millions

Posted by Colin Hill on Sep 3, 2015 7:30:00 AM

It’s the end of the day.  Joyce, a dedicated care manager, has just enough time to make one more phone call. It needs to count.

It’s an issue every care management team faces every time they pick up the phone, yet despite fierce market competition, the vast majority continue to use the same rules based criteria to figure out who Joyce should call next. Rules-based analytics rely on a few simple data points, such as estimated income, access to transportation, and smoking status...leaving enormous blind spots

A growing number of clinical leaders, however, are connecting care management interventions to individual value. The value-based analytics approach leverages every data point to select the intervention that will have the best health outcome at the lowest cost. This approach looks at hundreds of variables, not just a handful, to simulate every possible combination and outcome. The process examines millions of combinations to create trillions of data points, ultimately revealing the optimal mix of interventions matched for maximum value to individuals. Unlike the rules approach, this value-based methodology is hypothesis-free, meaning it has no pre-defined notion of the individual characteristics that describe a member who will benefit from intervention.

The value-based approach brings a competitive advantage to the intervention selection process by putting clinical leaders in an active role and enabling collaborations with analytics teams. The patented GNS machine learning platform ranks members by the value an intervention can deliver to each individual. The process reveals the true value of all interventions, whether vendor-based or developed in-house. This makes it possible for care managers to choose people for intervention based on how much each person will benefit from a given intervention, as opposed to setting a crude rule that may have no relevance for that patient’s individual needs.

 In our conversations with clinical and analytics leaders, many are inspired by the opportunity value-based analytics brings to improve outcomes and the patient experience while reducing costs. By informing health plans’ and other stakeholders’ accelerating investments in population health programs, GNS allows these organizations to:

  • Optimize internal care management staff resources
  • Maximize investments with intervention partners
  • Confidently deploy intervention programs
  • Improve health outcomes

Colin Hill is chairman and CEO of GNS Healthcare. He can be reached at [email protected]

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