Risk Adjustment

Building a data-driven care plan

Payers have had health care data capture and analytics capabilities for several years now but have been primarily mostly focused on patient populations that are at high risk. To date, much of it has been either hard core, evidence-based clinical data collected as a result of spending a lot of money, or it’s consisted of anecdotal evidence showing efficacy of alternative and often “unstudied” treatments. But we now have the power to align these two to improve patient outcomes in new and exciting ways.

Today’s healthcare environment is certainly data rich – no one disputes that. And by exploiting increasingly powerful analytical tools and remote monitoring capabilities, doctors can now use the  “torrent of information” to generate new robust patient-centric approaches to healthcare.

We call this the “data-driven care plan”. Let us give you an example of how this might work.

Mary Smith is in the hospital. She is over 65 and based on statistical evidence, there is a chance that she will be back – 20% of people in this demographic are back in the hospital within a month after their initial visit. So how do we keep her from returning?

One way is to capture various health-related data points such as diet, medications, blood pressure. But instead of having this information stuck in a clinical database somewhere or in the doctor’s email inbox, it is used to build a profile that can be pro-actively monitored. This is not complex, connecting these dots, but to date the mind set and needed processes to implement were missing.

Plus, given the recent advances in remote monitoring capability, caregivers now have the ability to access a wide range of health-related data points including cardiorespiratory activity, blood pressure and glucose levels as well as vital signs and many others – all while the patient is comfortable and at home.

Using data collected remotely, a nurse could make sure Ms. Smith is taking her meds every day. Using a smartphone, a caregiver could check to see if she is making it to her doctor’s appointments – monitoring when she left her house, how she traveled, how long she was away, when she returned. And then check with the doctor to corroborate.

By better collecting and connecting healthcare data, we can enable doctors to provide much more impactful interaction with patients. We are excited about the transformative potential of the “data-driven care plan” and look forward to contributing to the evolving solution.


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Presentation @ RISE VBC: Effective Collaboration Strategies Between Payer & Provider