Using Numbers to Improve Members’ Health

Certainly you’ve heard of paint-by-number, and if you’ve ever assembled a piece of furniture or a child’s toy, you know that requires following a numbered schematic. But what do numbers have to do with improving health?

Quite a lot, actually.

It’s called “predictive analysis,” and health insurers and clinicians use special software to identify certain populations of people by various qualifications to determine if they can make changes in the way healthcare is delivered and get better outcomes. Starting in 2007, Optima Health used its own employees to see whether predictive analysis would have an impact in its wellness program, Mission: Health.

In an article for the prestigious journal Healthcare Informatics, Karen Bray, Ph.D., R.N., vice president of clinical care services for Optima Health, talks about how Sentara Healthcare’s Mission: Health wellness program improved awareness and treatment of health risks such as high blood pressure and also reduced costs.

There wasn’t a blueprint existing for what Optima Health was doing, so it had to create its own risk models, Bray says. Optima took claims and lab and pharmacy data it had access to and ran “what-if” scenarios, which allowed the team to create parameters and definitions for the program.

By doing that, Optima found that there were three conditions – diabetes, coronary artery disease and congestive heart failure — that accounted for 14 percent of its costs. Sentara employees who were at risk for those conditions were identified and were given incentives of up to $600 per year (reductions of their health premiums and other health care incentives). These employees were rewarded for reducing health risks and complying with evidence-based guidelines by working with nurse case managers and health coaches.

The program paid for itself by 2009 and Sentara Healthcare realized $3.4 million in savings by 2010. Five years into the program, Sentara Health has continued saving money and employees continue to improve their risk factors. The program has been expanded and now includes seven large employer groups representing approximately 90,000 members.

There are many other uses for predictive analysis, such as identifying gaps in medical care and helping to reduce hospital readmissions. But at Optima Health, we’re thrilled with the results of this numbers tool for helping our members get and stay healthier – and for reducing costs.

If you would like more information about Optima Health’s wellness programs, contact us.