Since Geisinger Health Plan began predictive modeling for Health Navigator, its medical home program, nearly two years ago, the payer has seen a decrease in hospital admissions for its high-risk members in disease and case management.

The case management team is now applying program resources to its moderate risk and well segments of its membership.

“While it is too early to calculate an ROI, we have seen a significant improvement in our HEDIS rates for many preventive care measures,” said Janet Tomcavage, Geisinger’s vice president of health services.

Geisinger identifies lower risk members using multiple methods, including electronic health records, site registries and MEDai’s predictive modeling tools. “Some groups that we target include those who have not had their colon cancer screening or mammograms,” Tomcavage said. “Using this information, we are able to reach out to these members with reminder phone calls and letters, and schedule appointments if necessary.”

Identifying patients at risk or near at risk for intervention will “move the needle forward” for predictive modeling for disease management, said Lynne Dunbrack, program director for Health Industry Insights. Identifying a pre-diabetic, for instance, for early intervention will create savings down the road, she said.

MEDai is seeing more health plans establish medical homes, said Rebecca Susic, director of account management. The model puts nurse managers in the physician’s office to offer additional support.

“The primary care physician doesn’t have all the information on the patient,” Dunbrack said. “The nurse managers have the full picture. They have access to patient-level information through our application.”

Predictive modeling is a critical piece for medical homes. “You need to be able to identify patients for the medical homes,” she said.

Moving many of the normal health plan business services out to the primary care site, including predictive modeling, disease and case management services, performance feedback and so on creates a win-win-win situation, Tomcavage said. The physician gets additional resources in the office, the patient has someone to turn to and the health plan is able to strengthen the provider partnership and member relationship, thereby improving the communication and ultimately the member’s health outcome, she said. n
MORE AT HealthcareITNews.com
le Connect: MODELING 0809