These technologies frequently use current or historic data, including predictive modeling and the use of data to improve quality and safety, to identify individuals at risk.
Health plans that use predictive modeling are increasingly able to identify individuals who are predicted to have a costly or adverse health event, such as a hospital admission or emergency room visit. Carriers can then develop insightful and accurate reports from their large databases providing information about such high-risk individuals.
This information may be provided to a treating physician, who can work with the individual on early prevention and detection programs or other steps that can offset or prevent more serious health issues. Alternatively, it may be used to get the individual involved with a disease management program. Overall, it can help improve an employee's quality of care and reduce costs for both the employee and the employer.
Quality and safety
Leading health benefits companies are investing in helping to improve the quality and safety of medical care. Through sophisticated data-mining programs, data can be collected, combined and analyzed to create meaningful information that physicians can use to improve clinical quality and patient safety.
By comparing data with treatment recommendations, errors and gaps in treatment plans can be discovered. Carriers can arm physicians with information that can be used to improve patient care and avoid adverse health events.
To illustrate, a review of medical, lab and pharmacy claims for Mr. Smith following his recent heart attack suggests he is not using a drug referred to as a beta blocker. Evidence-based standards indicate a beta blocker could help reduce his chances of having another heart attack. This finding may be communicated to his treating physician, who then can evaluate if he should be prescribed a beta blocker.
The bottom line
A carrier's ability to skillfully and accurately collect and integrate data is a powerful tool that can influence medical management, and overall patient management, in a positive and beneficial way. Employers looking to manage health care dollars should consider a carrier that is investing in innovative health care technology focusing on quality and safety. It could an important first step toward keeping your employees - and your bottom line -- in good health. Dr. Burton VanderLaan is a board-certified oncologist. He serves as regional medical director for Aetna and is responsible for quality and utilization activities for a 16-state region. He is a member of the board of governors and a past president of the Institute of Medicine of Chicago, and has served as a member of the board of trustees of the Illinois Hospital Association. He also is a fellow of the American College of Physicians. Reach him at (312) 928-3580 or VanderlaanB@aetna.com.