Scott Wanless, principal management consultant for Fujitsu Consulting’s Business Intelligence Practice, coined the term “preparatory” analytics to describe what the predictive analytics market is evolving towards. If a provider or payer sees its diabetic population rise by 37 percent, for instance, reactive analytics focus on what to do with premiums. Predictive analytics enable the provider or payer to focus on reclassifying those members who were borderline and are now full-fledged disease management candidates. With preparatory analytics, disease management companies, providers, payers and patients win no matter if the population goes up or down, he said. Preparatory analytics takes decisions made with predictive analytics and works upstream to deliver inputs, which would include implementing wellness programs that will also positively impact co-morbidities as well as address the original issue of rising diabetic population.
TWO TRENDS TO WATCH
Scott Wanless of Fujitsu Consulting identified two trends impacting predictive analytics:
1. EXPANSION: Predictive analytics is moving beyond traditional areas of fraud detection and disease management stratification to medical tourism, retail health clinics, and new business channels such as the newly insured.
2. PRIVACY: Decisions being made using patient data, such as post-claims underwriting, are becoming increasingly under the scrutiny of privacy groups, consumer advocacy groups and regulators.
3. INTEGRATION: Providers are looking for integrated applications and systems and the elimination of bolt-on technologies.
VENDOR SHOWCASE
ActiveHealth MGt.
Clinical Stratification & Identification through Active Disease Management
The Clinical Stratification and Identification (CSID) tool uses CareEngine technology and evidence-based clinical content to identify and stratify members of a population who are most likely to benefit from Active Disease Management, a DM program that addresses more than 35 conditions.
Contact: ActiveHealth Sales, 888.803.7430
Business Objects
Predictive Workbench
Because BusinessObjects Predictive Workbench is a powerful solution that can help serve as your crystal ball, your organization remains more agile and stays one step ahead of the competition. Predictive Workbench is instrumental in helping solve other business problems specific to your industry, such as forecasting costs and logistics planning. It is the premier predictive analytics solution that allows experts in business processes, data, and modeling to collaborate, explore, and build prediction models. It also supports the proven industry-standard CRISP-DM methodology, which is the favored approached to providing predictive insight consistently and repeatedly.
Casenet
Casenet Care Management Solution 3.0
Version 3.0 offers fully integrated population management tools designed for use by public/private payers and wellness companies. 3.0 is a member-focused solution providing easy-to-use reporting tools and “always-on” availability as well as true collaborative care by giving multi-disciplinary teams the capability to consolidate member information into a single holistic view.
Contact: Christina Chase, 888.701.0886, info@casenetinc.com
Cognos, an IBM company
IBM Cognos 8 Business Intelligence (BI)
IBM Cognos 8 BI enables guided exploration and analysis of healthcare information to gain a complete view of the clinical development process; monitor trial performance against key milestones like IRBs, enrollment and drug shipments; and structure reporting aligned with strict regulations.
Contact: Susan Noack, global healthcare director, 602.663.0519, susan.noack@us.ibm.com
DST Health Solutions
DSTHS CareAnalyzer
DSTHS CareAnalyzer allows care managers to more effectively identify high-risk members by integrating elements of patient risk, care opportunities and provider performance. CareAnalyzer uses industry-accepted methodologies such as The Johns Hopkins University ACG System and NCQA’s HEDIS and provider performance measurement.
Contact: Sam Schoenauer, 866.287.9243, inforequests@dsthealthsolutions.com
Ingenix
Impact Pro
Impact Pro is a predictive modeling and care analytics solution that enables care management teams to utilize member-centric clinical, risk and administrative profile information to increase care management effectiveness, increase organizational competitiveness and enhance the ability to better meet regulatory compliance needs.
Contact: Eric Chetwynd, 781.419.8434, Eric.Chetwynd@Ingenix.com
MEDai
Risk Navigator Suite of Predictive Modeling Solutions: Risk Navigator Clinical, Risk Navigator Financial, Risk Navigator Performance, Risk Navigator Provider, Risk Navigator Guidelines
Predictive modeling suite that offers payers and providers a robust data analysis and reporting environment that enables them to share valuable clinical information, strategically manage medical and revenue enhancement opportunities, eliminate fragmentation in healthcare delivery and better allocate expensive resources.
Contact: Lizzy Feliciano, marketing, 321.281.4480, lfeliciano@medai.com
MedAssurant
ePASS (Electronic Patient Assessment Solutions Suite)
ePASS (Electronic Patient Assessment Solutions Suite) enables health plans to provide their physicians with Internet-based patient data history and impactful assessment tools at the point of care - delivering meaningful clinical care considerations, improved disease documentation, superior risk-adjusted reimbursement accuracy, and added value in the health plan/provider relationship.
Contact: Kyle Bray, 301.809.4000, ext.1243, kbray@medassurant.com, or 800.390.3180, info@medassurant.com, sales@medassurant.com
MEDecision
Alineo
Alineo, a collaborative healthcare management platform for case, disease and utilization management, provides a simplified and smart process for analyzing and identifying high-risk patients, applying clinical intelligence and automating healthcare program administration and best practices to improve the overall quality and affordability of healthcare.
Contact: 610.540.0202, ext. 1277, salesinfo@MEDecision.com
SAS
SAS Analytics
SAS Analytics cover a range of solutions including forecasting, data mining, optimization, visualization and simulation methods for the analysis and interpretation of data to reveal patterns, anomalies, key variables and relationships, leading to new insights for guided decision making.
Contact: Mary Grace Crissey, 210.957.4060, MaryGrace.Crissey@sas.com
Solucia
PROSpect software application
PROSpect is a medical savings opportunity assessment, financial impact, sales and reporting application that helps employers, health plans and care management companies understand opportunities within patient populations, identify patients for care management programs, determine program pricing/staffing and provide employer- and plan-specific cost/benefit estimates.
Contact: Ian Duncan, 860.676.8808, ext. 10, IanDuncan@soluciaconsulting.com
Tableau Software
Tableau 4.0
Tableau connects directly to a wide assortment of data sources, integrating data exploration and visualization to make analytics fast and easy for nearly anyone of any experience level.
Contact: Elissa Fink, vice president of marketing, 206.633.3400, efink@tableausoftware.com
USER REVIEWS
“Ingenix has given us an easy-to-use, self-serve tool to look at and manipulate our data to determine where we need to focus our efforts in medical management. We have found our team at Ingenix to be helpful during our implementation process and on an ongoing basis.”
Lesson learned: “During our implementation, the mapping of our data to meet the requirements of Ingenix required high involvement of our data analytical staff to make sure the data feeds were accurate and would provide us with the information we needed to successfully utilize Impact Pro.”
Julie Pofahl, director of utilization management, Dean Health System
“For us as an IT company, this tool helps to justify our investment in better care-coordination solutions – as part of our Population Health Management Program – because we can direct those activities to the right subsets of members.”
Lesson learned: “The biggest lesson learned would be identifying the appropriate site for data extraction, the skill sets needed to perform this process, identifying the resources that meet the criteria and pulling together the right team.”
Carla Davis RN, BSN, MS, director of medical services, MED3000
“Tableau’s simple and intuitive interface enables Kaleida Health to make sense of the more than one million patient encounters we have per year while identifying outliers, trends and opportunities that had previously remained hidden in the data, allowing us to drive positive changes in healthcare to the community we serve.”
Lesson learned: My team had to learn to think creatively about the story we were trying to tell (or to discover) and break the mold on how we had been doing things for the past decade or so before we used Tableau. It takes a different mindset, but once you break old habits, the process of analysis and discovery becomes fun again.”
Dan Gerena, director, business intelligence/corporate analytics, Kaleida Health.