Hospitalization and Risk Adjustment solutions validate additional predictive accuracy of Predilytics' unique approach
SCOTTSDALE, Ariz., Oct. 23, 2013 -- Predilytics™, the advanced predictive analytics company dedicated to answering healthcare's toughest questions, today announced the market availability of two healthcare analytics solutions, Predilytics Hospitalization Solution and Predilytics Prospective Risk Adjustment Solution. The two solutions address some of the most pressing and vexing issues in healthcare today, and both are being launched at the Care Continuum Alliance (CCA) Forum here, including presentations and discussions with population health professionals in the company's booth (booth number 214).
Hospital admissions account for 31 percent of total healthcare spending in the US1. Unnecessary hospital admissions represent an immense source of avoidable cost, and hospitalizations are a powerful determinant of overall quality of care and outcomes.
The challenge is in predicting which health plan members are headed for a future hospitalization, what that hospitalization episode is likely to cost, and which members can be positively impacted and at the same time be receptive to recommended interventions. Predilytics Hospitalization Solution provides answers to all these critical questions, and has shown results superior to "traditional" analysis methods.
For example, working with a Northeast health plan, Predilytics Hospitalization Solution proved to be 50% more accurate than previous "best practices" models in predicting hospitalizations. Overall, the solution delivers the following benefits:
- Early and accurate identification of a plan's highest-risk members
- A deeper understanding of member risk and receptivity
- A roadmap to better allocation of valuable resources
As an illustration, using the Predilytics Hospitalization Solution to improve targeting and to prioritize strong interventions, the company estimates that a Medicare Advantage (MA) plan with 100,000 members could achieve a 5% reduction in impactable admissions, resulting in savings of up to $12 million.
Appropriate risk adjustment for members covered under a Medicare Advantage plan remains a challenging and at times haphazard exercise. Sub-optimal performance on this critical function has significant quality of care and financial consequences, with billions of dollars at stake annually nationwide.
Predilytics Prospective Risk Adjustment Solution addresses this critical requirement. It identifies and prioritizes individual members for appropriate coding, pointing the way to proactively prioritize scarce risk adjustment resources. In one instance, Predilytics analysis identified the highest-opportunity members among an MA population, who are predicted to generate 25% more coding value with the same resource investment.
The Prospective Risk Adjustment solution also predicts the likelihood of individual members' consenting to an in-home assessment, allowing health plans to avoid chasing members who are likely unwilling to participate. Working with another Northeast health plan, the Prospective Risk Adjustment Solution identified members who are over 20% more likely to accept in-home assessments. With an intuitive dashboard, the solution also allows customers to actively monitor risk adjustment activities on an ongoing basis.
"Predilytics Prospective Risk Adjustment Solution has given us new analytic capabilities that we can apply to enhance quality of care, ensure proper reimbursement, and improve our network management," stated Stacy Coggeshall, MSN/MBA, director of risk adjustment operations at Tufts Health Plan - Medicare Preferred. "By using the concise and accurate information from the Predilytics model, we're optimizing our prospective targeting, and improving our in-home assessment resource utilization."
"The impact we and our customers can have on clinical, quality of care and financial outcomes is significant," summed up Chris Coloian, Predilytics president and CEO. "Preventing avoidable hospitalizations can be worth millions of dollars annually, if we can arm at-risk organizations with the insights to prioritize their interventions. Add in the hundreds of dollars per member per month with proper prospective risk adjustment, and there are typically additional millions of dollars in appropriate reimbursement available. We look forward to bringing these solutions to a broad market, and to continuing to apply our unique methodologies to additional healthcare opportunities."