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By Frank Richter, Chief Financial Officer
The future of healthcare is all about data. Insights from patient data analytics used in Direct Contracting Entity (DCE) , soon to be ACO REACH, care models can not only be used to pinpoint issues that may currently be causing a patient to experience hardships but also help providers prevent these patients from future catastrophic incidents or hospital admissions. Here’s how:
What is case management and how can it help improve patient outcomes?
Simply put, case management refers to identifying members who are at the highest risk of becoming catastrophic—the sickest of the sick, with the greatest potential for repeat admissions. Providers use the insights from artificial intelligence data and other information to help them develop a care plan, ensuring that the appropriate resources are focused on the people who truly need it most in hopes of getting the best results for the patient.
Also, data-driven case-management reporting helps eliminate unnecessary use that may result from being passed from specialist to specialist with little managed care. Improving efficiencies within the system helps reduce unnecessary costs, hospital admission, trips to the ER and more.
How do patient data analytics influence case management?
BrainStream, ilumed’s proprietary analytics platform, uses several score cards to give providers an amalgamated health profile of a patient. Past visits, lab results, prescriptions and virtually everything else about a patient’s medical history are included, letting a provider see at a glance if there’s something going on that needs to be addressed.
For example, if a patient has diabetes but only refills his 30-day prescription every other month, this could indicate financial hardship. This patient may have to choose between getting the medication he needs or buying groceries. Using his scorecard information to spot this patient’s lack of medication adherence, ilumed’s non-clinical outreach team can connect with this patient to determine why his prescriptions are not getting filled every time and help find ways to make getting the medication he needs easier and more affordable.
Because providers need to see a certain number of patients per day, they have a limited amount of time to spend with each patient. They don’t have the ability to follow members after they leave the exam room to ensure they’re going to specialist visits or being seen by their primary care physician (PCP) within 72 hours following hospital discharge. The easy-to-read, easy-to-use reporting data from BrainStream augments providers’ resources and give them the information they may not otherwise have access to. Our data is not siloed—we work alongside providers, integrating BrainStream’s data with their existing reporting systems so they’re acutely aware of what’s going on with their patients at all times.
What people get wrong about patient data analytics
When you hear the phrase “data analytics,” it’s easy to assume that it refers to looking at what has already happened and acting on it retroactively. It’s true that a lot of patient data analytics is predictive—we’re working proactively to look at other factors, like social determinants of health, that can lead to catastrophic cases so we can prevent them before they happen.
Another misconception people may have about patient data analytics is that it takes the human element out of healthcare. We have teams of people who work directly with patients and providers to give patients the best quality healthcare so they can have the best possible outcomes. Our teams use patient data insights to ensure that the most high-risk patients are being helped first, so it’s really all about people first.
What sets BrainStream apart from other data analytics applications used in DCE care models?
BrainStream was built with value-based care (VBC) in mind from the ground up. The staff at ilumed has been in VBC for over 30 years. BrainStream was designed to bring together every possible component of a patient’s care to allow us to effectively care for patients to achieve the best possible outcomes, while providing industry leading quality of care. By using artificial intelligence to look at patients with multiple hospital admissions in the past, we can capture them prior to being admitted to the hospital and becoming catastrophic. We’re not just looking at what’s happened and acting on that, but also what we predict may happen based on prior events and jumping on that to get high-risk patients enrolled in case management.
The bottom line
We have incredible amounts of data that can be used to predict what patients will need in the future and to catch potential issues before they balloon into catastrophic events or hospital admissions. BrainStream summarizes this volume of data and information in an efficient and effective way for providers, with the key elements highlighted in a very digestible format. In this way, ilumed leads the charge for giving providers what they need to take the best possible care of their patients.
Want to know more about how ilumed is helping providers heal healthcare? Contact us today.