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Case Study

Translating uncertainty into opportunity

MedInsight analysis supports achi’s Impact Tracker for clinical interventions

 

At its roots, achi was born to address the social determinants of health (SDoH) that too often impact care quality, patient outcomes, and even employee performance. With expanded data-driven solutions and value-based strategies from assets acquired from Front Health in December 2021, achi is further equipped to impact clinical outcomes and access the difference interventions make.

The challenge

Providers, payers, and self-insured employers spend meaningful dollars on care interventions like care management. However, their actual impact on clinical and financial outcomes is often misunderstood. Impact analyses either aren’t done, due to limited bandwidth or analytical complexity, or they are done too simplistically. This leads to relying on either a gut feeling, or insufficient approaches that could lead to the wrong conclusion about the efficacy of these programs.

A changing landscape

Transforming how healthcare is paid for and delivered is more important than ever to address high costs and an increasing disparity in outcomes among different populations. The key players in healthcare delivery include providers, payers, government, PBMs, employers, brokers, etc., and they have a role to play in new operational processes and financial incentives.

The provider role

Providers serve a unique role because they have the primary clinical relationship with patients and are increasingly positioned to take on some financial responsibility for the costs patients incur. By sharing in the financial risk with payers and the patients they serve, providers are incentivized to invest in preventative care. They play a primary role in improving patient outcomes and reducing the likelihood of patients incurring expensive services (e.g., Emergency Department/ED visit or inpatient admission). Anchored in strong, primary care relationships between patient and physician, providers offer programs like comprehensive care management that assist patients with chronic conditions, or those at risk of developing chronic conditions, to manage their health outcomes.

The approach

achi’s Impact Tracker

achi focuses on equipping payers and providers with high value capabilities, such as the Impact Tracker. This comprehensive tool delivers statistically-validated insights into the impact care management programs on quality and financial outcomes. Key components include:

  • Robust matching of intervened and control patients, including addressing selection bias
  • Consistent approach across all clinical interventions
  • “Best in class” visualization to surface nuanced insights

The Impact Tracker applied to a diabetes management program

A $4 billion provider asked achi, operating as Front Health at the time, to develop an approach to lower the costs of their self-funded employee health plan diabetes population and assess the impact of the management program on key clinical and financial outcomes.

The solution

Patient identification

achi leveraged MedInsight’s Chronic Conditions Hierarchical Groups to identify patients who were driving expenditure due to the severity of their condition. This analysis allowed achi to narrow its intervention to patients whose diabetes was their most severe, and costly, condition. Using MedInsight’s Health Cost Guidelines Grouper, achi also discovered that diabetic costs were spread across settings when compared to achi’s population-based benchmarks. Since spend was not concentrated in any setting, the most effective approach to management was a holistic one.

The diabetes management program

The program addressed diabetes care across different settings, including lifestyle, nutrition, and education. This interdisciplinary design empowered patients to manage their condition and reduce their long-term healthcare costs. With this program operationalized, the achi team then set out to address the program’s impact.

Measuring the impact of the program

To identify the longitudinal impact of the diabetes management program, achi used MedInsight to measure patient utilization and expenditure. The team evaluated the statistical significance of pre- and post-program enrollment changes in patient behavior and cost. These changes were compared to control groups that did not receive care through the diabetes program. To mitigate selection biases, the control groups were created by matching patients on age, sex, MARA risk, and chronic condition. achi then evaluated the program outcomes at six, 12, and 18 months post-enrollment to provide a longitudinal view of the patient’s health outcomes and the client’s savings.

Outcomes

achi worked closely with the provider to translate the findings from the analysis into operational improvements. The longitudinal analysis showed that savings in the diabetes management program did not come until 18 months post-enrollment, emphasizing the need for a long-term approach to evaluation. When looking at utilization, enrolled patients increased their medication adherence and decreased ED utilization when compared to the control group, indicating that the patients’ abilities to manage their diabetes improved. Through this project, the provider gained transparency into the performance of its diabetes program. They were equipped with the data and direction needed to make guided decisions for managing and expanding the program, allowing for more patient improvements and less system spend.

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