In this fourth installment of our Healthcare Horizons: Innovating Cost Management series, we explore how health claims analytics serve as the foundation for effective population health strategies. At inHealth Strategies, leveraging claims data and advanced analytics not only helps define the health landscape of a population but also plays a crucial role in mitigating risks and reducing costs.
The Power of Health Claims Analytics in Population Health
Health claims data is an essential tool for understanding and managing population health. At inHealth Strategies, we use this data to pinpoint what drives healthcare costs—and how to address those factors through targeted, value-based strategies.
- Stratifying Population Health Risks: One of the key strengths of inHealth is its ability to stratify populations based on detailed health data. This process involves categorizing individuals into cohorts based on their health risks and needs. Such stratification allows for more targeted health interventions and personalized care pathways, which are more likely to yield better health outcomes and cost savings.
- Identifying High Utilizers and Preventable Costs: Studies and data analyses have shown that a small percentage of the population often accounts for a significant portion of total healthcare expenditures, primarily due to chronic conditions and high-cost acute events. inHealth uses predictive analytics to identify these high utilizers and the factors contributing to their health status, which often include preventable or manageable conditions.
Integrating Social Determinants of Health (SDOH)
Health begins outside the exam room. That’s why inHealth incorporates Social Determinants of Health into its data analysis. This approach recognizes that factors such as socioeconomic status, education, and living conditions play a substantial role in individual health outcomes. By linking SDOH with internal claims data, inHealth can provide a more comprehensive overview of health risks and tailor interventions that address these broader health determinants.
Technology and Tools: Powering Population Health Insights
Our data infrastructure is built to support health claims analytics, enabling real-time analysis and precision targeting.
- Data Warehousing and Integration: Health claims and supplemental data are organized and continuously fed into a robust data warehouse, allowing for real-time data analysis and intervention planning.
- Predictive Modeling and AI: Advanced algorithms and artificial intelligence are used to forecast future health events and identify impactable cohorts within the population. This proactive approach helps in designing preventive programs that not only improve health but also reduce the need for costly acute care services.
Case Studies: Demonstrating Impact and Savings
Our data-driven approach has delivered measurable outcomes for self-insured employers and health systems:
- Diabetes Management Success: For a self-insured employer facing rising diabetes-related costs, inHealth designed a value-based care model that integrated personalized care management with biometric screenings. This program significantly improved clinical outcomes and achieved a $130 per member per month reduction in diabetes-related costs, alongside a 13% average A1C improvement in the first year.
- Reducing Acute Care Utilization: Another employer experienced saw a drastic reduction in acute care admissions and a significant increase in preventive screenings as a result of inHealth’s targeted interventions, which were informed by detailed risk profiling and health data analytics.
The Importance of Leadership Buy-In
Leadership buy-in is not just beneficial; it’s essential for the success of wellbeing programs. When leaders actively support and communicate about the benefits of these programs, it sends a powerful message throughout the organization. inHealth assists leadership teams in crafting messages that underscore their commitment to health and wellness, thereby enhancing the credibility and perceived value of the programs.
Leaders who champion wellbeing initiatives help cultivate an organizational culture that values health, which can significantly influence participation rates and overall program success.
A Foundation for Smarter, Cost-Efficient Health Strategy
The integration of comprehensive claims data and sophisticated analytics forms the foundation of effective population health management. These health claims analytics tools not only help in identifying and addressing current health issues but also in predicting future trends and needs, allowing inHealth to help organizations like inHealth to stay ahead in providing effective, cost-efficient health interventions.
As we continue to explore the intricacies of cost management in healthcare, it becomes clear that data is not just a tool but a fundamental asset in transforming the health landscape, ensuring that interventions are not only timely but also impactful. Stay tuned for our final next post in the Healthcare Horizons series, where we will showcase a case study that illustrates how inHealth leverages data to revolutionize healthcare strategies and outcomes.