Analytics enable more robust case management
Case managers can improve outcomes and lower costs when they help employees and their family members to avoid catastrophic events by improving their health through timely interventions.

Case management is enhanced when an analytics engine calculates care gaps and predicts the likelihood of hospital admissions, as well as readmissions in advance. Examining data from claims, pharmacy and clinical sources – and benchmarking it against real-world health data that has been adjusted for comparable demographics, geography and industry of the employer – helps case managers identify people whose health profile suggests elevated risk. Armed with this information, case managers can improve outcomes and lower costs by helping patients avoid catastrophic events with timely proactive interventions.



Quality data and predictive analytics can help health plans provide the touchpoints and targeted services their clients are looking for. With the right data at your fingertips, you can see not only diagnoses but behaviors – such as how many doctors a person sees and the prescriptions they fill – including any that might cause dangerous drug interactions.

ER avoidance through telehealth and driving down pharmacy costs
Another pain point for many employers is the overutilization of costly emergency rooms. To mitigate this, they are focusing on incorporating telehealth solutions to strategically improve population health. Data analytics can pinpoint the most acutely and chronically ill patients so they can be targeted with personalized treatment plans, including telehealth options such as remote patient monitoring. The data allows the prevention of hospitalization and readmission by predicting acute medical events such as congestive heart failure.

Employers are interested in access to sophisticated data analytics that pinpoint the most acutely and chronically ill patients in population health programs to connect them with effective, cost-efficient telemedicine programs.

Winning with data
Health plans have enormous amounts of data at their fingertips, and using that data to create a continuous feedback loop to provide actionable services that can be measured ongoing is attractive to potential and existing clients.

About the Author: Taylor Godbey is the executive vice president and COO at Advanced Plan for Health.
Back to HCB News

Business Affairs Homepage