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.

Download the Analytics for Disease Management and Wellness 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.

After graduating with a Master’s in Health Administration, I followed a career path into the hospital setting and was fortunate to build a telehealth /telemedicine program, from the ground up, for a large IDN in the Midwest.    This foray into Health Information Technology (HIT) was a great experience learning how technology applications can improve access to specialized healthcare and substantially improve the quality of life for patients in rural areas.

The technology of ‘Informatics’, however, was very new to me.  A basic understanding of the field and recognition of the US health delivery systems need for more targeted, tailored healthcare led me on a new career path with an analytics vendor.  What was surprising, initially, is the lack of understanding of this field and the ambiguous terms and definitions.  Using data to help make better strategic decisions has generally been understood as a good approach, however most adopted decision support techniques simply mine and re-organize existing data elements to make it more consumable.

The difference between data queries (i.e. pulling your own reports) versus having clinically relevant data automatically pushed to decision makers is what is going to make a difference in the future.  Artificial intelligence and advanced predictive models have been developed based on their ability to map patterns between relevant data points.  Vast data repositories with millions of patient records provide a robust foundation for the development of such models and will only continue to grow during the adoption of electronic health records.  The intelligence of the models is such that is allows unique characteristics of data sets (or populations) to automatically adjust the models as required to produce the most accurate outputs.  The science and math, however, do not negate the need to integrate clinical expertise into the data mapping process.

Many in the clinical community are going to be required to adopt a new mindset around the use of data concerning their patients.  The ability of computers and their vast processing ability should not be ignored but rather used to augment the physician’s expertise and wisdom based on his/her past experiences.  This science can then allow clinicians to maximize their time with patients and focus on the individual characteristics of each patient that may not show up in the numbers…

This type of predictive science has been slow to come to healthcare even though it’s been used in other markets for several of years.   The perverse incentive structure in healthcare today is partially to blame and has become the focus of several recent government incentives and legislation.  Physicians, hospitals, and other providers will now be accountable for the care they provide and the outcomes of their patients, and will no longer be paid based on the amount of procedures.  The consumer is also becoming accountable for their own physical health and for selecting the highest quality providers to provide their care.  Accurate, credible data is the key to empowering these types of decisions to be made.

The next decade promises to hold unfathomable advances in the field of informatics as it relates to healthcare.  Arguably the most deserving field for such technology applications will begin to catch up to other more retail oriented solutions.  As we learn more about our own health, and the data that supports our insurance ratings, we can begin to play a more active role in improving our own health status, and ultimately the quality of the care that we receive.

How will this level of access to clinical data help the healthcare industry to realize the aggressive goals laid out by legislators, regulatory agencies and commercial insurers?  How do providers and payers alike leverage the influx of newly accessible data and use it for clinical transformation and coordinated efforts?  The advent of blended organizations such as ACOs bringing unique data needs to healthcare related organizations and now, more than ever both payers and providers share both population management and provider performance goals.

In this recorded web seminar, Clayton Ramsey, COO of Elsevier/MEDai and Dr. Sanjay Udoshi, Physician Lead, Clinical Decision Support of Geisinger Health System, provide insight into what comes next.  Also, how to maximize the use of newly accessible clinical data, combined with longitudinal claims data to achieve new levels of accountable care, drive performance initiatives and identify and stratify patient populations for effective management programs.

Fill out the form below to download a complimentary copy of the web seminar recording

(please note that the file size is approx. 30MB)

With the ACO initiative scheduled to launch in January 2012, hospitals, physician practices and insurers are announcing their plans to form ACOS.

The ACO model requires providers along the continuum of care to share the responsibility for providing care to patients and take on risk together as one entity.   Health plans can play an important role in ACOs because they track and collect data on patients, which is critical for coordinating care and reporting on the results.   Health plans can play a critical roles in such initiatives by providing tools and data to support population based care, providing programs and staff to better coordinate care, and structure provider contracts to reward high quality performance and reductions in cost.    While providers and health plans work on creating new reimbursement models to support these changes, provider care systems are finding an escalating need to have access to analytics derived from claims data.

The joint webinar by Grow Forward and Elsevier / MEDai was designed to provide health plans with a base understanding of how their wealth of analytic information can provide significant value to provider care systems that are taking on the challenge of Accountable Care.  Listen to this  On-Demand Webcast for our expert consultant Eric Pierson.   Click here to view.   We look forward to hearing your comments!