What hospitals can learn from a population health vendor re-adjusting its focus toward specific care management

Predictive analytics are a powerful tool, but the investment often comes with a desire to maximize the return -- to get the most bang for one's buck. The key may just lie in micro-targeted member engagement, honing in on care gaps with a certain degree of specificity.

At population health services outfit AxisPoint Health, that philosophical shift has made all the difference. The ROI its predictive analytics deliver for payers serving Medicare, Medicaid and vulnerable populations has increased significantly, and it all started by shifting away from a macro, broad-brush approach to care management.

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"One of the key attributes is really focusing on the care gaps and the needs of an individual in a very precision-oriented way," said AxisPoint Chief Medical Officer Virginia Gurley, MD. "We really target a single care management or self-care behavior at a time. Many care management programs will actually start from the point of, 'Does this individual have a particular target condition, and what is their risk related to utilization and cost?' We've stepped away from that big-picture view."

When they've reached out to individuals and engaged with them -- say, someone with diabetes who's having trouble adhering to the medication -- they've seen an uptick in interest. With an initial acceptance rate of about 30 percent in terms of enrollment in the program, the team has seen much higher rates of engagement and retention.

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There were a few different factors that played into this strategic pivot.

"The boil-the-ocean approach to identify all the possible risk factors in someone, revealing a care plan that could have 20 different factors in it, was overwhelming for the participants and also the care managers," said Gurley. "Even if the care plan was prioritized, it was overwhelming to think they could work their way through all of these risk factors and health changes. Having that focus really gives the manager and the participant a much greater sense that they can achieve positive behavioral change, and not be so overwhelmed."

In addition to optimizing the ROI, it moves the timeframe much closer to the time of the intervention. But that's not to say there aren't challenges. AxisPoint had to completely rebuild its workflow tool, enabling it to effectively prioritize and rank a given population, and updating the content to make it much more focused.

The payoff, said Gurley, is that care managers' sense of accomplishment and job satisfaction is much higher. Knowing how to tackle a given issue has become much simpler.

"If someone's issue around medication adherence is related to side effects, that would be relevant to an RN," she said. "If someone's issue is related to remembering to take their medication, being assigned to a coach who can help with developing a reminder system can be more effective. If their issue is financial, a social worker would be more effective."

While early results have shown savings, exactly how much the approach stands to save remains unclear; at this early point, not enough data exists to quantify it. But that's the next step, and in the meantime, Gurley has identified a few best practices around predictive analytics that have come to light through AxisPoint's work in care management.

"Even using traditional methods of regression analysis to really identify the people who have the highest risks for the target risk factor you're trying to impact, we've found that to be very effective," she said. "When you're trying to reduce the risk of readmission, modeling to predict who is likely to have a readmission event allows you to be much more focused and able to bend the trend of that readmission rate."

By performing a forecast of the savings, comparing utilization rates and cost among adherent and nonadherent members, AxisPoint will be able to put a dollar figure on the savings it has seen, and it will be one of the few insights that exist into the cost and return of care management.

"One of the things I find exciting about this approach is that the ROI around care management has really been a black box," said Gurley. "This becomes an ability to shine a light in the black box."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com