To read more fill out the form below to download the white paper: The Three Best Drivers for Supporting Quality Mandates

It’s not that physicians don’t want to improve quality and reduce costs of care.  In fact, physicians believe that we have been and remain the true champions of quality improvement, that we are the truest patient advocates.  This belief is at the core of the physician culture.  However, the yang to this yin is our belief that non-physician stakeholders (payers, including at the federal level) and non-clinical data (such as claims data) is solely targeting cost reduction and to the exclusion (and even detriment) of quality.

Thus, the major challenge to engaging providers in true clinical integration and healthcare reform is not technological, as predictive analytics solutions have guided payers in identifying cost efficiency opportunities for decades.  Rather, the greatest obstacle to realizing successful reform is cultural.  Predictive analytics solutions and other historically payer-utilized reform tools must be modified to “speak to” providers and provide clear clinical value.  In addition, providers must be educated to appreciate that cost efficiency goals are not inherently anti-patient, and, in fact, that higher quality care delivery should cost less (that is, that cost efficiency and quality improvement are two sides of the same coin).

Today, predictive analytics are beginning to bridge this cultural gap.  New predictive analytics solutions that speak the providers’ language are offering opportunities to both improve quality and reduce cost at the bedside in real or near-real time.  Such solutions offer a “win” for payers, providers, and patients.  This is only the beginning of the provider empowerment revolution.  Today’s tools will evolve rapidly, allowing real time intervention, education, and communication with patients to drive health care towards higher value, preventative, ambulatory care.

Learn how the use of common language that is meaningful to both payers and providers allows users to perceive the same information as relevant, understandable and impactful.   If you are attending HIMSS, I invite you to see a demonstration of the new MEDai Navigator Physician Portal, visit Booth #6129 during exhibit hours or click here to schedule a meeting and product demonstration. Each participant who schedules and attends a product demonstration meeting will be entered to win a new iPad mini.

You can also find me at the Clinical & Business Knowledge Center at 2:00 PM on March 4, 2013.  I will be speaking on “Predictive Analytics for the Bedside Provider” – Booth 869 Kiosk #4.  See more

I look forward to meeting you.

Dr. Peter Edelstein

 They were looking for a predictive analytics solution that would:

• Identify the right people for care management
• Help nurses more effectively do their jobs
• Help deliver care to patients with chronic conditions.

The case study shows how Gilsbar achieves a 166% return on investment using MEDai Navigator for Population Health Management. 

Please complete the information to recieve a copy of the case study.

As the largest health care insurer in the nation, Medicaid costs topped $466 billion in 2011, for approximately 60 million beneficiaries. Health reform expansion will add 16 million enrollees, mostly in private plans, bringing the total number of Medicaid beneficiaries nationwide to about 65 million and raising the stakes for controlling costs. States will continue to look for ways to better manage Medicaid programs, improve outcomes and control costs, and are relying more on health plans to manage their Medicaid patients.

States are turning to MCOs to provide care for more medically complex, older, disabled – and expensive – populations with the goal of improving their health status through an integrated system that coordinates care and promotes wellness. Beneficiaries with mental health or substance abuse diagnoses are at 30% to 50% higher risk for chronic illness than those without behavioral health issues.

Facts About Medicaid State Spending

Focusing on prevention and providing alternatives to high cost services and settings while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs. Monitoring and managing patients in an outpatient setting rather than an acute care setting will be required to meet new payment models.

The value of managed care results from providing the right amount of health care, at the right time, in the right setting. Focusing on wellness/prevention and providing alternatives to high cost services and settings, while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs.

Analytic tools are needed to manage Medicaid beneficiaries and will be a key element to success to providing value to States that need to make their health care programs more efficient and effective. Predictive and clinical analytics will be an essential tool to create targeted programs for Medicaid MCOs to help identify high-risk members, track healthcare metrics against benchmarks and provide care managers with access to current clinical and financial data.

Elsevier/MEDai’s advanced analytics capabilities allows Medicaid MCOs to be better positioned to support State Medicaid objectives of decreasing administrative and medical costs, providing high quality care coordination to Medicaid beneficiaries and maintaining overall program integrity.

Managed Medicaid solutions enable effective decision-making delivered through advanced analytics by providing the tools for:

• Management of High Risk Populations, particularly dual diagnoses beneficiaries (exponentially more risk and cost)
• Collaboration of Care that is Critical to Cost Reduction and Better Outcomes for Beneficiaries
• Identification of High Performing Providers
• Program Integrity

Webinar Recording – “Top 6 Issues Driving Technology Adoption in Medicaid” – a joint presentation with Joint LexisNexis”
Request Audio and Presentation

As the largest health care insurer in the nation, Medicaid costs topped $466 billion in 2011, for approximately 60 million beneficiaries. Health reform expansion will add 16 million enrollees, mostly in private plans, bringing the total number of Medicaid beneficiaries nationwide to about 65 million and raising the stakes for controlling costs. States will continue to look for ways to better manage Medicaid programs, improve outcomes and control costs, and are relying more on health plans to manage their Medicaid patients.

States are turning to MCOs to provide care for more medically complex, older, disabled – and expensive – populations with the goal of improving their health status through an integrated system that coordinates care and promotes wellness. Beneficiaries with mental health or substance abuse diagnoses are at 30% to 50% higher risk for chronic illness than those without behavioral health issues.

Facts About Medicaid State Spending

Focusing on prevention and providing alternatives to high cost services and settings while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs. Monitoring and managing patients in an outpatient setting rather than an acute care setting will be required to meet new payment models.

The value of managed care results from providing the right amount of health care, at the right time, in the right setting. Focusing on wellness/prevention and providing alternatives to high cost services and settings, while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs.

Analytic tools are needed to manage Medicaid beneficiaries and will be a key element to success to providing value to States that need to make their health care programs more efficient and effective. Predictive and clinical analytics will be an essential tool to create targeted programs for Medicaid MCOs to help identify high-risk members, track healthcare metrics against benchmarks and provide care managers with access to current clinical and financial data.

Elsevier/MEDai’s advanced analytics capabilities allows Medicaid MCOs to be better positioned to support State Medicaid objectives of decreasing administrative and medical costs, providing high quality care coordination to Medicaid beneficiaries and maintaining overall program integrity.

Managed Medicaid solutions enable effective decision-making delivered through advanced analytics by providing the tools for:

• Management of High Risk Populations, particularly dual diagnoses beneficiaries (exponentially more risk and cost)
• Collaboration of Care that is Critical to Cost Reduction and Better Outcomes for Beneficiaries
• Identification of High Performing Providers
• Program Integrity

Webinar Recording – “Managing Medicaid Patients with Physical and Behavioral Health dual Diagnoses through Advanced Analytics”
Listen to Podcast and Download Presentation

As the largest health care insurer in the nation, Medicaid costs topped $466 billion in 2011, for approximately 60 million beneficiaries. Health reform expansion will add 16 million enrollees, mostly in private plans, bringing the total number of Medicaid beneficiaries nationwide to about 65 million and raising the stakes for controlling costs. States will continue to look for ways to better manage Medicaid programs, improve outcomes and control costs, and are relying more on health plans to manage their Medicaid patients.

States are turning to MCOs to provide care for more medically complex, older, disabled – and expensive – populations with the goal of improving their health status through an integrated system that coordinates care and promotes wellness. Beneficiaries with mental health or substance abuse diagnoses are at 30% to 50% higher risk for chronic illness than those without behavioral health issues.

Facts About Medicaid State Spending

Focusing on prevention and providing alternatives to high cost services and settings while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs. Monitoring and managing patients in an outpatient setting rather than an acute care setting will be required to meet new payment models.

The value of managed care results from providing the right amount of health care, at the right time, in the right setting. Focusing on wellness/prevention and providing alternatives to high cost services and settings, while maintaining quality are among the objectives of all managed care organizations — and particularly the focus of Medicaid MCOs.

Analytic tools are needed to manage Medicaid beneficiaries and will be a key element to success to providing value to States that need to make their health care programs more efficient and effective. Predictive and clinical analytics will be an essential tool to create targeted programs for Medicaid MCOs to help identify high-risk members, track healthcare metrics against benchmarks and provide care managers with access to current clinical and financial data.

Elsevier/MEDai’s advanced analytics capabilities allows Medicaid MCOs to be better positioned to support State Medicaid objectives of decreasing administrative and medical costs, providing high quality care coordination to Medicaid beneficiaries and maintaining overall program integrity.

Managed Medicaid solutions enable effective decision-making delivered through advanced analytics by providing the tools for:

• Management of High Risk Populations, particularly dual diagnoses beneficiaries (exponentially more risk and cost)
• Collaboration of Care that is Critical to Cost Reduction and Better Outcomes for Beneficiaries
• Identification of High Performing Providers
• Program Integrity

Whitepaper – “Creating a Healthier Medicaid Population through Collaboration”
Download your complimentary whitepaper

In the US, health care is moving irreversibly toward clinical integration, in part in response to federal legislation, but also because of new care models that are focusing on improved patient care. To remain financially viable and healthy in the current regulatory environment, hospitals and health care providers must reduce readmissions, improve patient outcomes, increase patient satisfaction with care, improve resource utilization, and reduce operating costs. These outcomes rely on the integration of clinical information among primary care physicians, surgeons, emergency department staff, nurses, caregivers, and even payers.

 Historically, health care in the United States was local. One primary care physician provided care to a person from birth to old age. That model is no longer current. Today, an obstetrician delivers our children, a pediatrician cares for them when they are young, a primary care provider takes over in their adolescence, and a geriatrician may assume their care in old age. Across the lifespan there will be specialists, surgeons, and emergency department physicians who touch them for finite treatments or for ongoing care of specific, chronic conditions.

Because of changing way in which health care is delivered, the primary care physician has lost his or her role as captain of the health care ship, and the ship has been on an unchartered course in which care has become fragmented, repetitive, and overly expensive. Outcomes are harder to predict and manage, and patients suffer.

Models such as accountable care organizations and patient-centered medical homes are attempts to put the primary care physician back in the pilot’s seat, but those attempts can only be successful if there is a means to integrate the clinical care of the patient across multiple settings and a variety of providers. Improved care outcomes is the carrot that is enticing health care providers, hospitals, and payers to integrate clinical data.

Where there’s a carrot, often there is also a stick. This is true for health care and the stick is a big one wielded by the government. Federal regulations are shifting risk from payers to hospitals, and hospitals, in turn, are shifting risk onto individual providers. The government’s huge stick, in the form of reimbursement penalties and other reforms, will help to drive clinical integration because failure to integrate will be the demise of hospitals and providers alike.

Against this background, providers and payers alike are looking for ways to analyze care outcomes and efficiencies, and to predict those patients who can best be helped with disease management programs, careful adherence to treatment guidelines, or encouragement in patient self-management of health.

Elsevier MEDai has been at the forefront of efforts to integrate clinical data, analyze risks and gaps in optimal care, and predict future use of health care resources, with tools such as its flagship Risk Navigator, which manages populations and stratifies high-risk members.

 In the first quarter of 2013, Elsevier MEDai will introduce a new Physician Portal for Risk Navigator. The portal will give physicians a big-picture view of “whole” patients under their care. Physicians will be able to see all the touch points a patient has had with health care providers over several years. Prescription fills and refills, surgeries and procedures, and office visits across all providers of care will be integrated in the patient’s electronic data file. Physicians will be able to identify care that has not met the standards of clinical practice guidelines and patients who have not been adherent to treatment. They will be able to compare care for different patients with the same types of diagnoses to determine if costs or outcomes are superior with one intervention vs another. This information, coupled with a motivation index that stratifies patients according to their motivation to change behavior or adhere to treatments, will help physicians determine the best use of resources and investment of time to improve patient care outcomes for those at high risk.

Only by having a full view of patients’ encounters with the health care system—hospitals, outpatient care services, pharmacists, physicians, case managers, and more—can meaningful programs be implemented to improve health, drive down costs, and help to prevent admissions or readmissions to hospitals. On an individual patient level, disease can be better managed when gaps in care are identified and then mended. On a hospital and provider level, costs and resources can be better managed, penalties can be avoided, and the financial health of the health care system improved. And individual physicians may find they can retake the captain’s wheel and steer the patient’s care toward better health.