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LK 120
Application of predictive analytics and human capital risk index (HUI) to drive patient-centric care
LK 120
Application of predictive analytics and human capital risk index (HUI) to drive patient-centric care
Managing Partner & CEO at HCMS Group
Background Ability to measure health risk accurately, with a whole person centric approach and in a predictive way to identify those with high costs is critical. Health risk indices predictive of cost... Read more

Description

Background 

Ability to measure health risk accurately, with a whole person centric approach and in a predictive way to identify those with high costs is critical. Health risk indices predictive of cost are used to identifying those at high risk and those with the potential of high risk of health related events for intervention purposes and to measure the effectiveness of health programs, systems and organizations.

Method

The HCMS Human Capital Risk Index (HUI) is an accurate and easily interpreted measurement of a person’s health risk based on their medical diagnoses, prescription drug usage, disability, and workers’ compensation (WC) habits. For an individual with average utilization across all data types, the medical diagnoses make up about 70% of their score, while prescription drug and disability/WC history each comprise about 15% of the score. An average score is 1.0, and an individual with a score of 2.0 is considered to have twice as much risk. I HUI is individual HUI and p HUI is populate HUI.

This index is different from other commercially available health scores in that it does not associate a person with a single diagnosis. The HUI takes into account the complex interplay between diagnoses and appropriately weights based on the breadth and severity of diagnoses. The integration of disability and WC in the overall score is unique and important given that disability claimants drive 40-50% of medical spending.

When comparing HUI to competitor risk score, it is more predictive. This was a retrospective study using regression modeling to compare predictive power.

The HUI is calculated using our integrated data warehouse with its differentiated ability to support broad set of data feeds, quality management, Lean Six Sigma production process management and related
algorithms.

Results

1) effectiveness of employer onsite medical home; between 2011 and 2012 the onsite medical home patients health risk (pHUI) increased by 16% vs community patients whose risk increased by 24% (p<.0017). The onsite medical home managed cost per unit health risk (V/HUI) better than the community by $524 (p<.0003)

2) disease cluster analysis of regional medical center patients: Highest claims costs for the hospital center are from mental health ($100m) and musculoskeletal ($90m) categories of patients, followed by cardiac ($80m) and cancer ($20m). The highest health risk (pHUI) is for cancer patients- 6.7 and is lowest for mental health patients - 3.5; for these patients, majority of cost is unrelated to the major condition.

 3) effectiveness of clinical prevention program: patient in top 5% by cost (integrated benefits cost-$43,321)with risk index of 4 (iHUI) is seeing 20 specialists with 13 diagnoses (depression, anxiety, osteoarthritis, hyperlipidemia, obesity) and is on 11 unique medications. After 12 service hours with advanced level nurse, pharmacist providing whole person decision support related to decreasing medications, managing anxiety, improving job performance, specialist care reduced to 6 providers, medications down to 4, and iHUI risk score decreased 72% to 1.1 with annual integrated benefit cost of $4,321, down 90%.

Conclusion

The HUI is an illuminating metric to include in analyses when benchmarking the effectiveness or value of any patient centric health program, model or system.  

Dr. Gardner is the Founder and Managing Partner of HCMS Group LLC.  Dr. Gardner’s 40-year career includes medical practice and healthcare organization administration, health professions education, and health economics research.  He has founded and built significant value in several businesses and health organizations, and is an advisor to public and private sector organizations on health economics and healthcare reform. Dr. Gardner is a Wyoming native and received his post graduate education at the University of Rochester.

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