|
Notes on managed care
|
| | Goal of managed care - Keep them healthy |
|
| | |
|
| | Premiums are key to cost control |
|
| | In managed care, the only way to lower costs is by lowering premiums. But premiums are an enigma, since actuaries do not share the details of their calculations and treat them as proprietary trade secrets. Why are premiums higher in one region than another? The answer, with no supporting facts, is always, "They are sicker." Clearly, we need better answers. |
|
| | Costs and care are intertwined |
|
| | Cost reductions cannot be at the expense of quality of care or outcomes. So, it is important to constantly monitor the health of populations and ensure that care programs benefit them. |
|
|
| | Measurements needed to prove that care programs work |
|
| | Both the health of populations and changes in them need to be measured and monitored continuously. But how? |
|
| | CareMaps - A preemptive tool mitigating fraud and abuse |
|
| | By developing new metrics for health of populations and changes in them, and interpreting premiums in terms of treatment costs for chronic diseases, CareMaps offers a solution that also doubles as a tool to proactively deter fraud and abuse. |
|
| |
| |
|
|
CareMaps - a portable visual database that can be queried
|
| | Maps of prevalence, incidence rates and costs |
| | CareMaps uses claims data to capture prevalence and incidence rates of chronic conditions and cancer in populations, and their costs of treatment in interactive maps. The results are provided as color coded maps on a dashboard and are easy to compare regionally or year to year. It is deployed in the cloud or offered as a local solution, making it possible to query the underlying visual database and use filters to extract the best matches, without using the web. |
|
| | Deployment of resources based on need |
| | CareMaps may show that hypertension maybe an issue in some communities while in others it may be diabetes or high cholesterol. Rather than waste clinical and financial resources, care programs can be tailored to meet the urgent needs of communities and standardize care on optimal programs based on both cost and outcomes. |
|
| | Accountability: Ineffective programs result in increased spread |
| | When wellness programs are not working, many patients will develop chronic conditions. When primary care management of chronic patients are ineffective, they will develop multiple comorbidities. Multiple comorbid conditions are a sign of poor coordination of care.. All of these degradations in health are measured and displayed in time sequenced CareMaps. Identifying hot spots in care delivery makes it possible to take timely corrective actions, to tweak wellness programs, to change primary care management protocols or monitor coordination of care. |
|
|
|
|
|
