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Finding tomorrow’s high-risk patients

As the healthcare industry offers more ways to earn risk-based or value-based revenue, providers are more proactively coordinating care, engaging patients and managing population health. Analytics are fundamental to all of these strategies, even in small practices.

To be successful, physician practices need analytics that are predictive across multiple populations. They need to know who the high-risk patients are today, but they also need to identify the “rising-risk” patients. With intervention, these patients can have a healthier future.

The cost of unmanaged cardiac conditions

One healthcare organization evaluated its Accountable Care Organization (ACO) population with Johns Hopkins Adjusted Clinical Groups (ACG®), an industry standard to adjust risk and predict future healthcare usage.

With analytics, this ACO found that more than half of its patients were either high risk (30%) or very high risk (27%). Furthermore, it found that the average total costs were astronomically higher for these patients:

Next, the ACO looked at probabilities for hospitalization within high-risk patient profiles. It found that two out of three patients have a cardiac condition. Analytics revealed that cardiac patients who had not seen their primary care provider within the last three months had 21% more emergency room use and 51% more hospitalizations.

While the primary concern is making sure these patients receive the best care possible, there is also a financial component: overall costs for these patients is 48% higher than patients who regularly see their primary care providers.

This data represents an opportunity to better manage care for cardiac patients. If the ACO can get these patients to more consistently visit their primary care providers through care coordination and patient engagement efforts, it could potentially save as much as $12.7 million per year. Even if the ACO could only affect change with one out of every ten patients, it would save more than $1 million.

We can help you find unmanaged opportunities within your own healthcare community. Contact us for more information.

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