DOWNLOAD SLIDES The CDC reports that 6 in 10 adults in the US have a chronic disease and 4 in 10 have two or more. With the prevalence of chronic diseases in mind, it’s no surprise that they are the leading driver for the nation’s $3.8 trillion in annual healthcare costs, and the diabetic population…
Many healthcare systems have made creating high-quality and value-based care a top priority. Southwestern Health Resources (SWHR) used clinical data and predictive analytics to put a total cost of care plan in place to provide affordable and quality care to thousands of patients in North Texas and cost-effective care for their employers. Oftentimes in the healthcare market, purchasers…
The pace of change in the healthcare industry is accelerating with new therapies promising cures to previously debilitating or deadly diseases. Aging populations, and public health crises, such as addiction to opioids, are putting pressure on provider workloads and increasing patient safety risk and negatively affecting patient experience. Healthcare providers must rise to the challenges…
Machine learning is getting better at predicting things. There are now algorithms that improve the detection of diabetic retinopathy, predict the onset of sepsis, and help determine a critically ill patient’s risk of dying. But a piece of wisdom from Warren Buffet comes to mind: “Predicting rain doesn’t matter. Building arks does.” Even the most…
There is increased recognition for better methods to measure, predict and adjust for social risk factors in healthcare and population health. Current performance and quality measures generally do not take SRFs into account in the bonus/penalty structure, nor are SRFs generally included in most risk adjustment formulas. This can lead to unintended consequences, including the…
Imagine the future when you go to your doctor to be treated for some sort of ailment. After collecting and entering key data into an app, she’s presented with a clinical diagnosis and optimal course of treatment, including the correct medications. While she’s there to talk “human-to-human” to the patient, it’s a predictive model and…
Humans have been interested in artificial intelligence for as long as you or I can remember. If you’re a science fiction fan you’ll have seen it in both good (i.e. Star Trek’s Lt. Commander Data and Star Wars’ C3P0) and bad forms (i.e. The Terminator or Hal 9000 from 2001 – A Space Odyssey) since the 1980s. Suffice to say, we’re still…
One day you wake up with a pain in your side that persists. You want to be seen by a medical professional, but you don’t want to go through the hassle of making an appointment and schlepping to your doctor. Most large healthcare organizations now allow you to make an appointment with a physician and…
Medicare Advantage insurers that miss enrolling dual-eligibles are missing an opportunity, said Change Healthcare, which has introduced a combination of artificial intelligence and behavioral science to identify candidates. WHY THIS IS IMPORTANT Enrolling individuals dually-eligible for Medicare and Medicaid is good business for insurers who are already in the Medicare Advantage space. While this population…
High quality health plan customer service is critical for payers who want to create meaningful, positive beneficiary interactions. Customer service plays several important roles for health plans. In addition to the stand-alone goal of leaving members with a satisfactory experience, the quality of customer relations is included in NCQA’s HEDIS measures, one of the most…