Predictive modeling helps DM company focus on care
Managing the population one person at a time
Targeting the right members for intensive disease management is the key to a successful program, says Christobel E. Selecky.
That’s why her company, LifeMasters Supportive SelfCare Inc., spends a lot of time crunching data to predict the likelihood that patients with chronic disease will need help managing their conditions.
LifeMasters, a disease management company founded in 1994, sells its services to health plans, employers, and government entities with the objective of reducing the cost of health care for the chronically ill population by keeping them healthy.
The program’s goals are to help people change their lifestyles and to give the physicians better information about the patient with the end result of avoiding hospitalization.
"Everybody wins. The plan saves money. The physician has more information on which to base medical decisions. The patient gets better," says Selecky, chief executive officer of the Irvine, CA-based company.
Population-based disease management can be very expensive if you do the same thing for everybody regardless of the severity of his or her condition, she says.
"To make it cost-effective, you have to have some mechanism to ensure that you are delivering the right level of service to the right person at the right time. In this way, you can allocate the cost appropriately. We do manage the entire population, but we do it one patient at a time," Selecky says.
LifeMasters uses predictive modeling to develop individual profiles of people who are appropriate for disease management and creating intensive interventions for those who need the most help.
With predictive modeling, LifeMasters is able to look at past claims experience and predict which patients may end up costing money in the next few years.
"Predictive modeling means taking the information you have and trying to draw conclusions about what intervention that person needs right now and with whom you will be the most successful," she says.
LifeMasters identifies a client’s chronically ill population by using claims data and other information, or the health plan can do it itself. The company manages people with cardiovascular disease, diabetes, and respiratory disease, as well as comorbidities, such as hypertension.
"Many of the people in a disease management program have more than one health problem," Selecky says.
The company identifies the population and stratifies the individuals into various levels of intervention, depending on a variety of factors. First is cost. Those whose health care costs the most are put in the highest level. People whose costs are low, about 70% of a typical population, receive the lowest level of intervention
LifeMasters also examines pharmacy claims data. For instance, someone who is taking six or seven drugs should be in a higher risk category than someone who is on one drug.
The predictive modeling goes a step further and looks at pharmaceutical history to see if the patient regularly refills his or her prescriptions.
"We drill down on the claims, trying to build a profile of that person," Selecky says. For instance, if a person is on six drugs, has never missed picking up a refill, and understands his or her disease, that person may be on a lower level than someone who takes fewer drugs but refills them erratically.
"Over time, as we collect data from our program participants and from regular claims feeds we receive from customers and feed it back into the model, it helps us do dynamic stratification that allows us to continually move people up and down in the program based on their changing profile," she says.
For instance, if a patient seems to be getting his or her weight under control, the system flags him or her, and the health coach reassesses where the person should be in the continuum.
If patients are at a certain level or above, a LifeMasters representative calls them and does a telephone health assessment.
"This allows us to add more information into the database, such as their knowledge of their disease, their readiness to change, and any individual issues they have identified personally," she says.
Members receiving the lowest level of intervention receive phone calls a couple of times a year, a regular newsletter, and access to educational information and tools on the LifeMastersOnLine web site.
"We keep an eye on them and make sure they remain stable. We look at the claims on a regular basis to make sure there are no changes," Selecky says.
People on a higher level receive monitoring and education. They are assigned a health coach — either a registered nurse or a health educator, depending on the individual member’s severity and needs. The patients regularly enter data into LifeMasters’ database.
About half the people who are put into the high-level program need monitoring equipment. LifeMasters sends equipment such as blood pressure cuffs and scales directly to the program participants or works with the health plan to ensure they have monitoring equipment covered by their benefit plan, such as glucose meters.
The health coach teaches them how to use the equipment and provides them with a way to enter data into the LifeMasters database.
"We teach them self-care skills and act as a coach, working with them on weight loss, exercise, or whatever they need. We make sure they understand the disease and monitor what they need to be monitoring," Selecky says.
For instance, if the patient enters data that exceed the threshold set by the patient’s physician, the system automatically issues an alert to the LifeMasters nurses. The nurse calls and triages what happens next, whether it’s a change in patient behavior or a visit to the physician or the emergency department.
"By using our extensive database, the nurses can look at data from six months or more and compare them to what’s happening now. They can point out to the patient that they had the same reaction a few months ago when they did a particular thing. It makes for a more meaningful interaction," she adds.
The program uses a completely paperless system. Nurses and health educator undergo two months of training on how to use the system.
"I get e-mails from nurses thanking me for the computer system. They feel it helps them do a better job. Health care professionals like to feel that they have a real impact on a long-term basis. Our own people work with the patient and see them get better over time," Selecky says.
Targeting the right members for intensive disease management is the key to a successful program, says Christobel E. Selecky.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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