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Population Health Analytics Enables Rapid Identification of Super-Utilizers

Seeking to drive down unnecessary cost, Hospital Sisters Health System (HSHS) needed a way to automate risk stratification of patients who may benefit from care management services and eliminate the burdensome manual work its care managers were performing to identify at-risk patients. HSHS utilized a population health analytics platform to accurately risk stratify its care management and identify patients who would benefit from additional care management interventions.

Featured Outcomes

  • 100 percent relative improvement in efficiency for the risk-stratified patient identification workflow.
  • In just one day, the analytics application identified more high-risk patients than had been identified in the previous year and a half.

Analysis Reveals that Pharmacist-led Medication Therapy Management Reduces Total Cost of Care

Learn how Allina Health leveraged its analytics platform and Health Catalyst professional services to perform an analysis demonstrating the impact of pharmacist-led medication therapy management (MTM).

Featured Outcomes

  • $2,085 mean total cost of care reduction per patient in the six-month period after the first pharmacist MTM encounter; over $590,000 extrapolated out over 283 MTM patients.
  • 12 percentage point reduction in hospital admissions per 1,000 members and a 10 percentage point reduction in emergency department visits per 1,000 members.
  • Statistically significant decreases in average medication count.

A Better End of Life Experience: Enhancing Patient Care and Reducing Costs

By leveraging data from its analytics platform along with a risk predictive model to identify patients who would benefit from its home-based palliative care, Partners HealthCare has improved the end of life care for patients and reduced costs.

Featured Outcomes

  • $8,106 savings in total medical expenses in the last six months of life.
  • 67 percent of home-based palliative care program patients received hospice care at the end of life, compared to 40 percent of patients that did not receive this option.
  • Overall, patients who received home-based palliative care had savings associated with decreases in expense rather than utilization.

Integrated Care for High-Risk Patients: Keeping Patients Healthy and Costs Down for Over Ten Years

Five percent of patients account for half of healthcare spending in the U.S., and patients with multiple chronic conditions cost up to seven times more than those with only one. Read how Partners HealthCare has maintained its integrated care management program (iCMP) and is continuing to decrease costs while improving outcomes.

Featured Outcomes

  • $125 per member per month savings upon enrollment into the iCMP compared to patients not enrolled.
  • Similar to cost findings, the relative risk of any emergency department (ED) visits, non-emergent ED visits, and hospitalizations decreased as length of program enrollment increased, specifically for Medicare patients. In months 24+ in the program, the relative risks of all three types of utilization were lower than 0.60.

Integration of Community Health Workers Improves Care Management Effectiveness

The positive impacts of community health workers (CHWs) have been well documented, yet in general, CHWs remain underutilized and have not been fully integrated into care teams. Read how Partners HealthCare successfully integrated CHWs into its integrated care management program (iCMP) care team to improve patient outcomes and reduce cost.

Featured Outcomes

  • When the CHW functions as a lead, results include a:
    •  $664 larger per member per month (PMPM) reduction in total medical expense and an 11 percent larger reduction in ED visits compared to the control group.
  • When the CHW functions as a part of the care team, results include a:
    • $635 larger PMPM increase in total medical expense, however, patients with a CHW team member had a 28 percent larger reduction in ED visits, and an 11 percent larger decrease in office no-show rates compared to the control group.
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