Authored by: Laura Kanov, Senior Vice President, Product Strategy
A couple of years ago (almost to the day) I posted a blog entry on my LinkedIn page about “The Population Health Slide” based on this idea of a sigmoid curve or slippery slope between two extremes. On the one end, in an upper left quadrant if you will, are those who are healthy no matter how much you invest in their wellness activities. On the other end, or lower right are the unenviable folks who, no matter how much you spend on their medical, social or mental health care are not going to get any healthier or enjoy a better quality of life.
In the middle, however exist a population at the precipice, ready to slide or sliding from quadrant one to quadrant two who, if we could just identify them and understand what is causing them to slip, we could prevent or at least slow that deterioration.
Predictive risk algorithms play a key role in identifying those likely to slide from one point to the next, but as important is identifying a change in risk as a means to hone in on individuals in urgent need. But how do you discern between signal and noise?
In Spotlight 2.0, we’ve added a critical feature that calculates statistically significant change for each risk score and each individual in the population, displays them graphically and allows the user to create cohorts or drive rules from those changes. Moreover, the delta is calculated for a 30-day time period to capture sudden changes as well as a 90-day time period to find slow but steady changes. Lastly, any new chronic condition diagnosis is highlighted in the Risk Change Bins. Clients can use these new insights in many ways. For instance:
- Mitigating Rising Risk: This is the primary use case as alluded to in the opening paragraphs. Slowly or rapidly rising risk indicates a significant change in the individual’s clinical profile that warrants attention to prevent or slow the event, condition or cost.
- Graduate from Complex Care Management: Significant decreases in risk scores will occur when key features are addressed and fall off an individual’s profile, like historical costs & utilization, detrimental social determinants of health, and acute diagnoses. Case managers can use these to change the intensity of care needed for patients and members, thereby reducing costs and refocusing scarce resources.
- Engagement Strategies: Whenever a new diagnosis is made, it is a good time to make sure the individual is well informed of the condition, implications and any new therapies to improve compliance and motivation.