Proactive Care Management Leads to Better Cardiovascular Health, Lower Costs
By Wes Smith, FSA, CERA, MAAA | Vice President Actuarial Solutions & Client Engagement
Heart disease remains the leading cause of mortality in the United States, responsible for about 1 in 4 deaths, according to the Centers for Disease Control and Prevention.
But the healthcare industry’s shift toward value-based care is driving improvements to how heart disease is managed—leading to better outcomes and lower costs for health plans and employers.
In honor of American Heart Month, we’d like to share how advanced predictive analytics focused on opportunity, not risk, can lead to better cardiovascular health.
Traditional health management analytics—especially those provided by some of the largest legacy vendors—focus on retrospective measures of risk, such as a patient suffering a heart attack or being diagnosed with heart disease in the past year.
While effective health management is important for these members, retrospective measures leave out many additional members who have emerging clinical risks. These emerging risk members have not yet been diagnosed with a heart condition but, based on sophisticated AI-powered predictive analytics, are considered likely to receive a diagnosis in the year ahead.
By ignoring these members, legacy vendors focused on reactive measures of risk are providing an incomplete picture of health—and missing an important opportunity to proactively impact health outcomes and control costs.
The Solution: Prospective Opportunity Analytics
Instead, today’s leading healthcare predictive analytics vendors are focused on prospective opportunity analytics.
In the case of cardiovascular health, Certilytics helps health managers intervene before a patient suffers an adverse outcome—leading to healthier populations and lower costs.
We do this through advanced predictive analytics that focus not just on members already diagnosed with heart conditions, but on members at high risk of developing heart conditions.
We also focus not just on retrospective risk, but on opportunity—the value, in dollars, of intervening to mitigate or prevent adverse outcomes such as hospitalization or non-adherence to medications. This unique approach ensures that financial and clinical stakeholders are aligned in their strategy—resulting in more effective health management—as well as the ability to differentiate themselves from their competitors and clearly demonstrate value in performance-based pricing arrangements.
Recent case studies show the Certilytics approach is working.
In one recent analysis looking at members at risk for emerging conditions such as congestive heart failure, a national insurer achieved nearly $200 in PMPY savings after incorporating AI-powered member risk stratification tactics. These savings were relative to the insurer’s previous care management strategy, which focused on historic risk as opposed to prospective opportunity.
For a personalized consultation on how Certilytics can help improve heart health and supercharge your organization’s health management strategies, contact us here.