Predictive Analytics That Drive Performance Improvement Across the Continuum of Care
Healthcare spending is out of control. In response, CMS is taking steps to reduce costs by implementing a variety of programs to improve operations and outcomes and facilitate the transition from “Fee for Service” to “Fee for Value” payment models. These Pay-for-Performance (P4P) and risk-based programs are the driving force behind CMS’ reform initiatives and soon will be the industry standard. They require providers to submit quality measures calculated from patient data to payers, who then reimburse providers based on measure outcomes.
However, P4P poses challenges. To meet P4P program requirements, providers need information that enables them to anticipate patients at risk for high-risk, high-cost conditions and identify potential gaps in care. This information can then be used for targeted interventions at the point of care to improve outcomes. The majority of providers are only capable of manual data abstraction and retrospective analysis though, which does not allow for this type of real-time and near real-time care coordination. Providers need a predictive modeling and analytics solution that delivers timely, actionable information to fully maximize the opportunities of P4P and risk-based programs.
The flexible PredictiveCare360 platform uniquely positions SpectraMedix to execute a broad range of quality and performance improvement initiatives across the continuum of care using clinical and claims data. It uses predictive modeling to identify and assess both individual patient and population health risks, and delivers timely information that empowers providers to take immediate action to improve acute care and operational efficiencies. It also customizes information based on specific patient centers and circumstances, going beyond first generation clinical analysis to second generation psychosocial and behavior analysis by incorporating data such as family history and involvement in care.
How it Works
PredictiveCare360 is powered by the SpectraMedix 360 Predictive Modeling Engine which processes data electronically from the SpectraMedix 360 Enterprise Data Warehouse (EDW) or other EDWs. All major data sources across an enterprise are supported including EHR systems, billing, claims, lab, scheduling and other clinical systems. It then uses state of the art computer science, predictive algorithms, machine learning and data integration to deliver advanced business and clinical intelligence. The extensive capabilities of PredictiveCare360 are supported by a team of business analysts and data scientists with a depth of domain experience, ensuring that our clients successfully execute existing initiatives and uncover new opportunities to improve performance.
Information Delivery for Immediate Action
Providers should not have to make time to get the information they need. PredictiveCare360 combines integration with EMRs and other clinical and administrative system workflows with the SpectraMedix 360 Alerts Engine and messaging system for seamless delivery of information. Users can receive actionable updates via alerts, texts and emails on their mobile devices or by accessing a continually updated web portal.
Impact Care Delivery at the Point of Care
Healthcare professionals know that earlier treatment is more effective and less expensive than treatment delivered later. PredictiveCare360 predicts which patients are at risk of developing high-risk, high-cost conditions such as heart failure, pneumonia, acute myocardial infarction, chronic obstructive pulmonary disease, diabetes and renal failure upon admission and provides real-time treatment options. Algorithms assign patients with risk factors so effective decision making can begin immediately. Patient details are integrated with workflows for real-time monitoring, and alerts with recommendations for action are delivered to care teams at the point of care. This enables care givers to prioritize patients, optimize decision-making and provide targeted interventions.
Predictive Intervention for Acute Care and Ambulatory Care
The approach to healthcare management is changing from a standalone view of patient health to a system-wide view in which providers collaborate to coordinate care and are reimbursed based on performance measures. In this environment, the need for actionable data across the continuum of care that enables quality improvement is evolving. PredictiveCare360 enables a confluence between acute care data, ambulatory care data and the requirements of the new healthcare system model.
Predictive Intervention for Core Measures
The concurrent review and management of Core Measures is a proactive and timely approach to achieving Core Measures compliance. PredictiveCare360 combines our ability to predict patient conditions in real-time with our Measures Framework to identify patients that meet criteria for Core Measures and intercede at the point of care. This enables care givers to identify compliance failures and data gaps and take action while there is still time to correct them. It also provides the opportunity to impact the quality of care prior to discharge to improve outcomes. These abilities to impact both Core Measures compliance and quality of care in real-time would not be possible until weeks or months later with standard, retrospective Core Measures data. In all instances of measures failures or gaps in reporting, the SpectraMedix 360 Alerts Engine alerts caregivers to optimize patient/provider interaction.
Predictive Intervention for Readmissions
PredictiveCare360 leverages proprietary predictive models to identify patients admitted to the hospital that are at risk of being diagnosed with a condition that has a high risk for readmission. Patients are assigned readmission risk scores and recommendations for action which are integrated directly with hospital EMRs and other clinical and administrative systems to become part of daily workflows. Care teams can then use this information to prioritize patients and effectively allocate resources. PredictiveCare360 also enables providers to track at-risk patients from hospital to PCP to home to monitor and improve transitions in care. Additionally, it provides real-time reporting on readmission initiatives so decision-makers can regularly evaluate initiatives, share results and implement changes that have an immediate impact. These models enabled a New Jersey hospital to reduce its readmission rate for CHF by over 38% in 2013.
Predicting the Problem Patients of Tomorrow
In a system-wide view of patient health, inpatient and outpatient providers collaborate to coordinate care. PredictiveCare360 integrates with ambulatory EHRs to empower providers and decision-makers across a system to manage care and take preemptive action based on a complete view of a patient. It predicts which patients have the potential to become high-cost in near-term before they actually become expensive. This allows healthcare systems to confidently take on risk as caregivers can effectively distribute resources at points of care across an entire service area to keep patients healthy. It also enables acute and ambulatory care providers across the continuum of care to monitor P4P measures while patients are still under care and enhance operational efficiencies based on successful outcomes.