When Peoria Public Schools began working with AIMM the medical cost PMPM was close to $500 dollars. The group was eager to avoid cost-shifting and benefit erosion………………..Within three years, the medical cost PMPM have decreased by 25%.
HCRM and AIMM Helps Employer Group Achieve 25% Reduction in Cost Over Three Years
MyHealthGuide Source: Health Cost & Risk Management LLC (HCRM), 2/5/2018, www.hcrmnet.net
Predictive Modeling plays a key role in controlling medical cost and improving outcomes for health plan members. This capability allows clinical users to quickly and accurately identify and stratify members based on future costs and clinical risks to improve health and, therefore, reduce health plan costs.
Health Cost & Risk Management LLC (HCRM) began working with Ault International Medical Management LLC (AIMM) in 2008. HCRM’s clinical predictive modeling system processes 24 months of eligibility, medical and pharmacy claims with a number of statistical forecasting tools. The results are then integrated with an artificial intelligence to create a large, complex mathematical model for the population. The advantage of the prediction engine is it uses the right combination of linear and non-linear models to correctly “fit” the characteristics of the population. The system allows AIMM to quickly and accurately identify and stratify their population into cohorts of interest. AIMM can then identify people with high forecast costs or by disease state, e.g., diabetes, coronary artery disease or asthma and further assess them by motivation and/or compliance with gaps in care.
“The HCRM tool is an invaluable resource for us,” said Deb Ault, President of Ault International Medical Management, based in Columbus, Ohio. “Not only does it help us to identify the right patients to engage in medical management services, but it helps us to focus our efforts on patients who are not yet receiving the right care, are not getting care or medication refills at the right time, or whose health plan is not paying the right price for the patient’s care. It also helps us bring powerful information leading to creative solutions to our clients for ensuring their members are receiving care at the right place.”
AIMM uses predictive modeling services to build medical management programs to the unique specifications of each individual group. By understanding the population’s cost and risk through HCRM’s predictive modeling tool, AIMM can then formulate a medical management strategy that is the best fit for that group. The system provides predictions of cost and risk at the member level allowing medical management programs to be patient centric.
“My call center nurses absolutely LOVE this tool, because it enables them to focus their conversations and interventions with patients on those gaps in care and other clinical issues that are actually meaningful to the quality of the patients care and impactful to the health plan sponsor,” continued Nurse Deb. “We know that our patient’s want raises in their paychecks rather than increased health plan spend, and this tool helps us to achieve that for them.”
Using the HCRM tool AIMM is able to focus delivery of medical management on individual patients who are impacting overall costs for the group as a whole. This keeps administrative costs for medical management as low as possible, while simultaneously maximizing cost control.
Peoria Public Schools
AIMM has been working with the Peoria Public Schools since early 2014, utilizing HCRM’s predictive modeling solution. An analysis of cost per member per month shows significant cost reduction since that time. The graph below shows the per member medical cost (PM_MedCost) in blue and the rolling 12 month average per member medical cost (R12_Cost) in red.
|Peoria Public Schools
When Peoria Public Schools began working with AIMM the medical cost PMPM was close to $500 dollars. The group was eager to avoid cost-shifting and benefit erosion, was committed to providing, the highest quality of care, and also wanted to control cost. Due to AIMM’s ability to focus on the needs of high risk members and manage behavior change, Peoria Public Schools benefited from improved member health and reduced costs. Within three years, the medical cost PMPM have decreased by 25%.
Healthcare cost are rising and creating more pressure on Employers. Predictive modeling can help relieve that pressure with tools to
- identify health risks in a given population,
- quantify their impact on health benefit costs, and
- measure the effectiveness of programs in lowering those costs.
The analytics also prioritize individuals and determine the best approach to each person based on that individual’s motivation to change.
When discussing the Peoria Public School results with Deb Ault she explained, “We’ve been easily able to move beyond the industry norm of reactive or real-time or even proactive medical management to delivering Predictive Care Management. Through predictive modeling we can engage members in advance of serious health issues to enhance their quality of care and quality of life. We all know healthier people file fewer claims. This tool, however, helps us solve the timing problem associated with investments in health and wellness initiatives. Most groups are not in a position to invest now on a return they will receive 3 or more years in the future. This tool lets us intervene now with patients who are 1 year return on investment situations.”
HCRM’s predictive modeling system transforms large quantities of complex health care claims data into actionable information. It allows users to identify group level clinical issues and cost drivers, then quickly drilling down to member-level information that is crucial to managing their health. Effective intervention based on this information generates demonstrable savings and return on investment for the employer.
About Health Cost & Risk Management, LLC
Health Cost & Risk Management, LLC performs predictive modeling services and specializes in collecting and processing claims and related health plan data for Third Party Administrators, Brokers, Provider Networks, Physician Groups and other clients. HCRM provides monthly predictions of clinical events and associated costs for each member in their database. For each person, the system predicts medical costs, pharmacy costs, emergency room visits and inpatient days for the next 12-month period while also assessing compliance with national standards of care for 19 chronic diseases and four preventive categories. The information is used for disease management, large case management, on-site clinics and others to address the health care needs of their members.
About Ault International Medical Management (AIMM)
AIMM builds medical management programs to the unique specifications of each individual group. By understanding the client’s culture, population, goals, objectives, and budget we formulate a medical management strategy that is the best possible fit for them, and will generate the results they need to achieve. Tweaking and modifying the program as services progress ensures optimal success. AIMM’s team is as aggressive or as passive in our interventions as the client chooses. We provide our expertise, information, suggestions, and consultation, but ultimately it is the client who decides the format of their program, how much of an investment they are able/willing to make, and where they wish to deploy those resources. All AIMM services are centered on the concepts of being patient-centric, comprehensive, holistic, and fully integrated.
For more information about AIMM and their Medical Care Management solutions contact Nurse Deb at 877-254-5029 or email at firstname.lastname@example.org.