HCSC Cutting-Edge Predictive Modeling
Cutting-edge methodology pays for Care Management program many times over
Health Care Service Corporation (HCSC), the parent company of Blue Cross Blue Shield of Illinois, New Mexico, Oklahoma, and Texas, strives to demonstrate measurable improvement in clinical outcomes and does so by stratifying its entire membership based on each member’s health status and the potential for an effective intervention.
COURSE OF ACTION
The company worked with the Healthcare business of Thomson Reuters to develop an analytic methodology that stratifies its entire member population based on the types and severity of conditions and the potential opportunities for intervention. The methodology uses all available data in the analysis—not only claims data, but also lab results, demographic information, and lifestyle data. The goal of the methodology is to assign each member to one of the mutually exclusive, hierarchical groups based on Health Status Category and Opportunity Score.
This methodology uses multiple data sources to precisely analyze entire populations and deliver the results to clinical users—providing a true predictive model that utilizes both financial analysis and clinical indicators to stratify its members. This stratification is available at the plan, division, product, and employer group levels.
RESULT
Health Care Service Corporation’s innovative analytic methodology has had a positive impact on member care management, operational costs, and membership growth. Although it is too early to measure the impact of this program on reducing overall medical costs, based on the available literature, the company is confident that this methodology will enable their Care Management program to pay for itself many times over, while increasing the quality of care that members receive.
In leveraging Medstat Advantage Suite and the Medical Episode Grouper methodology, it has developed the next generation of algorithms for population segmentation. The combination of financial analytics and clinical indicators places Health Care Service Corporation at the forefront of true predictive modeling.