Manage clinical and financial risks with analytics

Until now, managing risk in health care has largely been an exercise that was left to the payers. Provider organizations haven’t needed to accurately calculate the clinical and financial risks associated with caring for patients, because they didn’t bear the liability. But the rise of value-based care and big data is changing the face of [...]
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Consumer engagement program paves the way for stronger member satisfaction, lower costs

With the health care system continually evolving, today’s consumers are playing an increasing role in choosing, utilizing and evaluating their health insurance plans. Plans must move beyond focusing on member acquisition and toward building a seamless, comprehensive and personalized experience that spans the organization and meets the current and changing needs of their members. This [...]
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Turn health care risk into opportunity with analytics

Managing clinical and financial risk in today’s ever-changing health care environment is a complex proposition. But with a good of understanding of patients’ potential risk for costly health complications, organizations can turn the risk of value-based reimbursement into opportunity to provide higher quality, more cost-efficient care. Advanced analytics can give health care providers the understanding [...]
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Identifying population risk in new members requires aggregated health status data

As new enrollees enter the market from public exchanges and expanded Medicaid programs, health plans must determine how to appropriately assess member health in order to align interventions and better predict costs. Doing so effectively, however, requires having access to as much information as possible. A combination of multiple data sets — including claims-based data [...]
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The power of prediction: Sentara Medical Group puts predictive analytics into action

In my most recent post, I wrote about usability factors in predictive analytics. In today’s post—the final post in the predictive analytics series—I’ll share an example of a provider that put all the predictive pieces together to transform its population health management program. Sentara Medical Group uses predictive models to identify high-risk patients, particularly those [...]
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Paying and saving for health care: How many steps are there?

If you had to guess, how many stages do you think your employees go through when paying and saving for their health care? Here’s a clue: The process is more complicated than simply “paying” and “saving.” According to Optum research of more than one million consumers and in-depth analysis of our account holder experience, your [...]
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Innovative payment approach for successful value-based reimbursement models

As you see health care transitioning away from traditional fee-for-service payments and toward performance-based payments, value-based reimbursement (VBR) approaches are becoming popular options for health plans. Pay-for-performance contracts, patient-centered medical homes, bundled payments and accountable care organizations offer unique value creation while allowing payer organizations to work collaboratively with their provider partners. Payers are looking [...]
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The power of prediction: Predictive analytics need to provide timely and actionable intelligence

In my last post, I wrote about the variables that determined the accuracy of predictive models. Accuracy, however, is only half of the equation. The data also must be usable; that’s today’s topic. Timeliness is a critical aspect of usability in predictive analytics. For a provider to deploy predictive modeling in their organization, their own [...]
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The power of prediction: Predictive accuracy depends on data set size, sources and quality

In my last blog post, I wrote about how predictive analytics needed comprehensive health care data to have a high degree of prediction. In today’s post, I’ll dig deeper into the variables the increase predictive accuracy.

The power of prediction: Predictive analytics help providers accurately identify high-risk patients

Readers of my blog posts have probably noticed an ongoing theme: Organizations taking the journey from volume to value need to apply advanced analytics to data to be able to manage risk and make the most out of value-based care. Over my next few blog posts, I’ll stick with that theme, with my focus on [...]
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