Find “Ticking Time Bomb” Patients

Problem

Benefit Managers feel defeated. For years they have provided expensive and broad-scoped condition management programs and have little to show for it - plus their people often end up in the hospital for avoidable reasons.

According to a Department of Health and Human Services study, 5% of Americans made up 50% of U.S. health care spending. And the top 1%? They drove 20% of medical expenditures.

According to the February CDC Grand Rounds, 33%‒69% of hospital admissions are due to members not taking their medication as directed. The cost of not taking medication is estimated to be between $300-600 billion dollars annually.

Can employers find the members that are at-risk before they end up in the hospital?

Solution Overview

• Focus on four contributing factors to catastrophic and costly health events:
  • Not taking medication as directed for multiple conditions and multiple years
  • Low health care cost/consumption of services
  • Age
• Report chronic medication non-adherence - over five years
• Provide a list of patients sorted by likelihood of bad outcomes
• Create cohorts of patients for outreach
• Measure outreach efforts and report to allow feedback to improve outreach

Process

1. Define the problem: research the factors that are most correlated with steep increases in healthcare costs.
2. Report on the issue in a way that is easy for HR teams to understand
3. Develop a sortable list of at-risk patients
4. Create a way to create and track cohorts