Alliance Community Hospital, is an independent 104-bed hospital with an attached 78-bed skilled nursing facility. The hospital strives for clinical transformation, which means creating a care coordinator network for patients experiencing significant social and economic barriers that affect their care, helping local employers increase primary care access to reduce emergency department (ED) use, and analyzing claims data for its own workforce to identify opportunities for improved care.
With VitreosHealth's predictive analytics solution, Alliance Community Hospital is able find that nearly 40 percent of employees or dependents fall into a “hidden opportunity” category.
The analysis of claims data suggests that Alliance Community Hospital could save more than $850,000—or nearly 12 percent of its total healthcare spending—if patients with chronic conditions received more timely care management, physicians had cost data about the drugs they prescribe, and employees had cost information that allowed them to shop wisely for prescription medicines.
In 2009, MCNT piloted projects with Blue Cross Blue Shield and CIGNA to serve as a Patient-Centered Medical Home (PCMH), when the two insurers shifted their focus from episodic care to coordinated care and long-term healing relationships.
By Karen Wagner
By using a predictive modeling tool to identify members at risk of becoming high-cost healthcare users, an oklahoma health plan is reducing per member per month costs while increasing member satisfaction.