With a rapidly expanding number of interventions, health plans are armed with new tools to improve the health of their members. In addition to traditional drug interventions, health plans are able to take advantage of new technologies to engage their members like wearables, hand held devices, online portals, care management programs, employer engagement programs and virtual or in-home care.
With the wealth of options, the challenge now is determining the timing and type of intervention that will best meet the goals of value-best care and the Triple Aim –improving the patient’s experience and health outcomes while reducing the cost of care. A one-size-fits-all approach is not enough to meet those goals because standard medical care is built on the average patient. And frankly none of us are average. To be effective, health plans need to rapidly identify which care management interventions are optimal for individual patients.
Personalized medicine means delivering the right treatment at the right time to the right patient. The GNS Intervention Optimization offering, powered by our REFS™ causal AI platform, runs multiple simulations that analyze outcomes and costs for millions of intervention possibilities to determine the types and timing of interventions that will yield the most beneficial results.
Intervention Optimization is distinctly different from population health initiatives. Instead of predicting patterns or relying on correlations, our solution discovers cause and effect relationships underlying the data, and then simulates future scenarios to give transparency and explainability into what works for whom and why.
GNS Intervention Optimization solution provides:
Identification of the underlying drivers of success for interventions
Targeting the costliest treatment areas
Cost savings through optimization across a suite of interventions and engagements
Ability to accurately view how patient non-adherence affects disease trajectory
Improved health for patients based on targeted individual interventions
Greater transparency across the organization
The Power of Intervention Optimization
The key to effective healthcare is determining the optimum intervention along the disease trajectory specific to individuals or groups of patients. The GNS Intervention Optimization solution defines points of initiation and targets patients best suited for an intervention strategy at key “inflection” points. The models are then used to match targeted patients to the intervention that is the most effective in reducing their risk of hospitalization, ER visits, and other health outcome, quality, and cost metrics. This allows health plans and their industry partners to determine how to get the highest value and best outcomes from their healthcare spend.
The REFS platform runs hundreds of thousands of simulations to generate disease trajectories for individual patients directly from vast data pools including EMR/EHR, medical and prescription claims, genetics, lab, genomics and demographics. This results in the member trajectory models that when simulated with care management interventions enable intervention optimization.