Dual physical-behavioral diagnoses dramatically increase the need for and the benefits of care management and patient engagement. Unfortunately, most clinicians and other decision makers lack the information needed to manage this complex, high-cost population effectively. They are awash in data but lack timely, actionable information on patient’s conditions and needs. For example, absent the right tools, physicians are often unaware of all of a patient’s co-morbidities or treatment, particularly for behavioral health diagnoses.

Medicaid expansion makes use of advanced analytical tools critically important. Under the Affordable Care Act, Medicaid enrollment will increase by 24 million, according to new estimates by the Centers for Medicare and Medicaid Services (CMS). All these new enrollees are adults under 65, many of whom have untreated physical and behavioral health diagnoses. By 2020, Medicaid enrollment will reach nearly 100 million.

On May 1, we sponsored a webinar entitled “Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics”.  Our main speaker was Kip Piper, a seasoned expert on Medicaid, Medicare, and health reform and a senior consultant with Sellers Dorsey.  He provided a high-level briefing on how using a combination of analytical tools can be used to improve clinical and financial outcomes in state Medicaid programs, particularly for high-cost, high-risk Medicaid beneficiaries with dual medical and behavioral diagnoses.

If you are interested in listening to the post event audio, please email l.roman@elsevier.com.

Download e-Book – How Market Leading Health Care Organizations Are Using Analytics to Drive a Competitive Edge.

We know that the incredible volume of data that flows through a healthcare organization holds the secret to improving care and reducing costs.  Unfortunately, most healthcare organizations lack the anlaytical support to turn data into positive insight. They are data rich, analytics poor.

Elsevier/MEDai has a very unique vantage point within the healthcare industry because we provide industry leading analytics to both healthcare providers and payers.  And from our vantage point, we see best practices and market-changing activities that are happening right now as the healthcare system transforms.  Our goal is to actively share our insights and our knowledge so that your organization may benefit.

A best practice that is rapidly developing is how market-leading organizations are rigorously taking stock of their analytic assets and using them to redefine the healthcare landscape and drive a new competitive edge.  These organizations have analytics available, but most importantly they are actively building them into how they do business.

Our new industry paper (Click to access the paper) showcases why analytic assets are quietly escalating in value and how these assets are quickly taking center stage.  The paper provides a common understanding of healthcare analytics and quickly moves to show how they are being used to drive change.  The key take-away from this paper is that it provides instruction on how to investigate your own organization to discover what opportunities may exist to increase your competitive edge and become a market leader.

Many of the themes at this year’s conference focused on transparency of data, performance, and measurement.  Other key trends at this year’s HIMSS included collaboration, integration, transitions in care, interoperability, and workflow integrated analytic solutions to meet the up and coming standards required for Meaningful Use Stage 2 and ACOs/value-based purchasing design.

With so much activity around the different facets of where the healthcare industry is going, it’s clear that a massive transformation is underway.  The transformation from a fee-for-service healthcare model to one based on outcomes.  Under this new model, providers will be taking on a greater portion of risk. In reward, these providers have an opportunity to receive a significantly higher net reimbursement.  As a result, the collaboration between payers and providers organizations is reaching new levels.

This is where Elsevier / MEDai comes in.  If you’re familiar with our company, then you’re more than aware that our 20 year history of providing analytic solutions to payers to help them manage risk, track utilization of services and understand the financial impact of their programs has been market-leading.  For providers, our rich history in helping care-giving organizations to build a platform of excellence by understanding causal factors for negative outcomes through performance measurement and benchmarking combined with real-time, patient specific predictions on their conditions sets the pace for everything a clinical analytics enterprise solution should deliver.

We welcome such a change in our healthcare environment as it means that the entire industry’s focus is now squarely on how to improve our current status and advance our care delivery system to world standards.  This should be the top of mind for anyone directly in or related to healthcare and Elsevier / MEDai is the only analytics company with a long, rich, proven history to deliver the necessary world-class analytics to get us there.  Analytics that drives clinical integration and fosters an environment of excellence, while delivering a cohesive approach to the overall improvement of the entire care continuum.

Health plans and health organizations need actionable data to provide proactive care.  Reducing cost through identification of employees at risk presents the highest potential benefit with predictive and clinical analytics.

With predictive and clinical analytics as a key tool, see how a forward thinking health plan works in partnership with a healthcare organization to implement an incentive-based wellness program for both the employees and the organization.  The program has seen a net savings of $3.4 million in healthcare costs which is a savings of $6 for every $1 invested in the program.

Our new case study shows you best practices that were  implemented by a nationally recognized health plan in partnership with a healthcare organization to achieve impactable results.

In October 2011, CMS released its final value-based purchasing rules for Accountable Care Organizations (ACOs), with a heavy emphasis on increased financial responsibility for healthcare providers, pegged to clinical performance. Hospitals and other ACOs — and their physician medical staffs — needed no greater illustration of the new reality, one in which they must keep costs down while maintaining good outcomes.

For more detailed insight into the importance of physician performance analtyics and the role it plays in the new era of accountable care, download the full white paper.

“With Elsevier / MEDai’s Risk Navigator Clinical, our clients will be able to measure and monitor compliance to evidence-based guidelines and provide information to employers regarding population and group management,” said Douglas Layman, Executive Vice President & CSMO, Gilsbar. “As more and more payers focus on gaining efficiencies and improving quality, the predictive modeling enabled by Risk Navigator Clinical will help our clients turn their data into actionable information so they can achieve both.”

Gilsbar, based in Covington, LA., is one of the nation’s fastest growing, private health and benefit management organizations. Gilsbar’s three divisions – including Health & Benefit Management, MedCom Care Management and MedCom Care Advocates – provide proven methodologies to help keep members healthy and curb healthcare spend. Gilsbar’s clients include benefit advisors, employers, associations, affinity groups, and insurance carriers.

“As Gilsbar supports its clients utilizing Risk Navigator Clinical, it can look forward to having a greater ability to identify and manage high risk populations utilizing claims and biometric data and ultimately improve the health status of their clients’ employees and families,” said Tom Zajac, President, Elsevier / MEDai. “Risk Navigator Clinical is the only predictive tool that gives payers a true 360-degree view of their member populations.”

Gilsbar also plans to use Risk Navigator Clinical with its clients to conduct group reporting, provide feedback to employer groups and incorporate risk scores into actuarial models.

“Risk Navigator Clinical will help Gilsbar to proactively select at-risk individuals for interventions more effectively than before and will improve their support of wellness programs,” said Hank Miltenberger, President and CEO of Gilsbar. “These programs will provide a demonstrated return on investment for our clients and improve the overall health of their members.”

For more information about MEDai’s Risk Navigator Clinical, please go to www.medai.com.

By helping employers change the way their employees use health services and reducing their  health claims costs, Healthstat provides measurable results where they matter most.

 That’s why Healthstat partnered with analytics and predictive modeling company, Elsevier / MEDai (Medical Artificial Intelligence).  Healthstat integrates not only the medical and pharmacy claims that are incurred outside of their clinics, but also their  Health Risk Assessment data, biometrics, laboratory readings, and clinic encounters within their clinics, to predict the risk of the population and the associated impact on cost. Through this merging of all the medical data, they can predict trends, identify gaps in care, and immediately recognize those cases with the greatest impact potential from both financial and quality of life perspectives.  Healthstat has the statistics to back it up. On-site clinics specializing in disease management, primary care, and episodic health care have shown a significant impact on reducing healthcare costs.

Costs go down while health goes up. It’s how Healthstat is helping build healthier businesses.

Download the case study.

The Health Reform Legislation will have an effect on the health insurance industry.  The PPACA law’s unprecedented changes will create serious challenges for the health insurance marketplace – increased competition for the group market, burgeoning numbers of insured patients, cost restrictions, complex compliance requirements, and new models of care.

The collaborative, integrated care approach of Patient Centered Medical Homes (PCMH), Accountable Care Organizations (ACOs) or any other emerging care delivery model requires highly developed technological infrastructure; access to accurate, timely, and comprehensive data; and integrated clinical and financial analytics.  Tracking meaningful results for the patient population and per-capita spending will be critically important in charting the success of these approaches.

Payers have an opportunity to partner with ACOs because they have the critical claims data that ACOs need to better monitor patients’ health, identify gaps in care, and mange risk.

To understanding this change, other emerging trends and learn what distinctive capabilities are needed to compete in the new healthcare landscape, download the Emerging Healthcare Trends whitepaper.

Orlando, Fla. – November 28, 2011

Elsevier / MEDai began with one simple idea: to help healthcare organizations transform volumes of clinical data into actionable insight, enabling better decisions and improving the quality, cost and effectiveness of the care process. Tom brings over 25 years experience in building clinical, financial, and operational performance improvement solutions for both vendor and healthcare organizations that provides a tremendous opportunity to energize the growth and vision of Elsevier / MEDai.

“Tom’s appointment comes at an important time as payers and providers are looking more to analytics to pull insights out of data to drive population management and physician performance programs, said Michael Hansen, CEO of Elsevier Health Sciences.  “Under his leadership MEDai will continue to help empower customers to make sound clinical and financial decisions that reduce risk, lower costs and improve the quality of care.”

Tom was formerly President of CareScience, spending eight years building the company into one of the leading providers of integrated quality improvement, regulatory reporting, outcomes research, HIE data exchange, and transformational services to over 250 health organizations. Prior to CareScience, Tom spent eleven years building Transition Systems’ (TSI) success as the leader in healthcare decision support, with 1200 US and international provider and payer customers. TSI was acquired by Eclipsys, where Tom established and became President of the Business Solutions Division, providing advisory and transformation consulting to customers across its spectrum of products.

“MEDai is in a unique position to impact the healthcare process, with our award winning clinical analytics, process knowledge, and clinical insight.” said Mr. Zajac. “Our role, as a true partner, is to provide our customers with product and service solutions that both support their current needs, and expands to support the industry’s evolution to true population health and longitudinal care.”

Tom is a Senior Scholar with the Jefferson University School of Public Health, is a prior contributor to the Center for Healthcare Transformation, and has presented at both national and international forums on healthcare management. Most recently, Tom was Managing Director of Zajac and Associates, LLC, providing product and strategy services to private equity, vendor and provider customers in healthcare.