How predictive modeling can prevent triple aim failures

Using predictive modeling to classify patient populations based on individual risk and anticipated response to an intervention can help hospitals achieve the much-touted triple aim goals of improved patient experience, better population health and lower per-capita costs, concludes a Walgreens study published this week in Health Affairs.

Doing so enables hospitals to better target preventive interventions at particular risk levels, thus avoiding "triple fail" events--incidents that are costly, represent a suboptimal outcome and a poor patient experience, according to the study.

"Our findings suggest that if organizations expand their thinking around how to classify patients in order to take a more predictive approach aimed at preventing triple fail events before they occur, the potential benefits for all stakeholders would be significant," Ian Duncan, Walgreens vice president for clinical outcomes and analytics, said Wednesday in an announcement.

Under this approach, hospitals must analyze medical and pharmacy claims, electronic health record information plus other administrative data to identify at-risk subpopulations, the authors noted. Hospitals can then tailor prevention efforts to the needs of the homogeneous subpopulation of patients at each risk level.

"For example, a program aimed at preventing hospital readmission might offer case management, telephonic care, and remote monitoring, with more intensive interventions offered to patients in higher risk strata," the study states.

The chief information officer of La Clinica de la Raza in in Oakland, Calif., Tina Buop, has made a strong business case for predictive analytics. "You can bankrupt an organization very quickly if you don't understand your patient population," Buop told FierceHealthIT in a recent interview.

With dollars at stake, her organization is using predictive analytics to reach out to at-risk patients, such as those with diabetes, to ensure they are getting preventive care, as well as to improve quality and efficiency.

Meanwhile, Catholic Health Initiatives is embracing a similar approach in its new analytics initiative, targeting at-risk populations to identify ways to better monitor and improve care.

For more:
- here's the Walgreens announcement
- check out the Health Affairs abstract

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