Self-insured hospital expands into accountable care

As accountable care gains momentum in healthcare, one hospital isn't just focused on the general health of the population it serves. Instead, It is primarily concerned with the health of its employees, according to MedCityNews.

St. Joseph Hospital in Nashua, New Hampshire, a regional, full-service healthcare system, self-insures its employees, so it has always had financial incentive to keep them healthy. However, many of those employees are in their 50s and 60s and at higher risk for illness than the general population. As such, St. Joseph expanded into accountable care for its employees.

Last year St. Joseph, part of the Massachusetts-based Covenant Health, enlisted a healthcare analytics firm to design an accountable care plan for its employees. The initial analysis found that while employees were fairly healthy, "it's their spouses who have the highest-acuity cases," CEO Rich Boehler, M.D, said, according to the publication. Analyzing insurance claims in combination with the data in the hospital's electronic medical records allows St. Joseph to develop the clearest possible picture of risk.

For example, patients at high risk of diabetes could be prescribed ACE inhibitors, and the claims database would enable the pharmacy to determine who is not filling their prescriptions. This capability allows case managers to analyze why, which Boehler said would provide an early warning if a patient stops taking needed medication. Such predictive analytics have helped other providers drastically reduce post-surgical infections and complications, FierceHealthIT previously reported, and the model will likely grow significantly over the next five years, according to a 2014 report from IQ41 Research & Consultancy.

Administrators, Boehler said, must take precautions not to violate employees' trust and keep employees' clinical needs between the employees and their care coordinators and case managers. Administrators like Boehler only have administrative access, rather than clinical access, to the database, he told MedCityNews.

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