AI-Enabled Care Management Reduces Healthcare Spending by $32.2M

HIGH COST OF TREATING PATIENTS WITH CHRONIC CONDITIONS

More than 90 percent of the $3.8 trillion the U.S. spends annually on healthcare is for people with chronic health conditions.¹Care management is key to decreasing unnecessary healthcare utilization, improving clinical outcomes, increasing quality of life, and lowering healthcare spending.²

IDENTIFYING PATIENTS MOST LIKELY TO OVERUSE HEALTHCARE SERVICES

UnityPoint Health recognized patients with complex chronic health conditions were overutilizing healthcare services, particularly when transitioning from hospital admission to an ambulatory care setting. Yet despite having access to large volumes of data, clinicians lacked timely insight into care provided across acute and ambulatory settings.

UnityPoint Health needed to be able to effectively identify patients with high or rising risk of worsening health conditions that often result in non-urgent ED visits or unplanned hospital admissions. Such visits and admissions limit the ability of its care management teams to intervene and provide the care patients needed. The organization desired to integrate AI into its analytics processes to predict which patients could benefit from enrollment in its care management program. The care management program enables care managers to intervene and prevent unnecessary healthcare utilization and reduce spending.

DATA OPTIMIZATION DECREASES UNNECESSARY HEALTHCARE UTILIZATION

UnityPoint Health建立了一个跨急性和门诊护理环境的护理协调框架，其中包括在整个组织内共享共同目标和工具的综合护理管理项目。该组织利用Health Catalyst®数据操作系统(DOS世界杯葡萄牙vs加纳即时走地™)平台和一套强大的分析应用程序，在其不同的系统中建立一个单一的世界杯厄瓜多尔vs塞内加尔波胆预测真相来源，并获得对患者特征和医疗保健利用模式的强大洞察。分析团队与急症和门诊临床医生合作开发并增强了该组织的分析工具，利用数据来减少不必要的医疗保健利用率，并确保数据在不同护理设置之间共享，以实现护理管理程序的优化和扩展。

AI TOOLS ENABLE EFFECTIVE CARE MANAGEMENT

UnityPoint Health uses numerous AI tools that incorporate chronic health data, social data, the probability of admission, and readmission risk after discharge from the hospital to risk-stratify patients and predict which patients are at high or rising risk for unnecessary healthcare utilization. The AI tools enable care managers to identify patients and prioritize them for care management engagement effectively. UnityPoint Health utilizes the following tools for efficient care management:

• Readmission Heat Map:risk-stratifies patients with inpatient and observation stays, identifying the risk of readmission within 30 days of discharge. The map indicates the specific days during which the patient is most at risk of requiring services. The insight provided by the Readmission Heat Map allows clinicians to visualize risk and act upon the information, adjusting the intensity and timing of interventions, ensuring the proper care is provided at the right time and in the right location to optimize outcomes.
• Population Health Toolkit:provides longitudinal details of the patient’s care experience, including hospitalizations, recent discharges, upcoming appointments, and missed appointments. Clinicians can gain detailed information from the toolkit about patients who could benefit from enrollment in a care management program. Clinicians also use the Population Health Toolkit to manage patient panels. Clinicians can quickly review the patient’s chronic conditions and recent ED visits or hospital admissions, allowing them to identify and address care gaps.
• Leadership Dashboard:提供护理管理操作和结果的整体视图，包括病例量、登记率、登记的患者总数、毕业率和转诊率，允许领导每天有效地监测项目。
• Outcomes Analyzer:enables real-time visibility into program outcomes, including system-level, region-level, and clinic-level performance. The organization can evaluate and compare the number of unnecessary ED visits and hospitalizations before patient enrollment in the care management program and after graduation. UnityPoint Health performs ongoing evaluations of program performance and quantifies patient outcomes and healthcare costs avoided.

RESULTS

In the 30 months since the care management program’s inception, UnityPoint Health has substantially decreased healthcare utilization and the costs of care for patients who complete the program. The organization has reduced healthcare spending by more than:

• $32.2M, the result of a 54.4 percent relative reduction in hospital admissions, and a 39 percent relative reduction in ED visits.
• Patients gained 11,000+ more days at home and had nearly 2,000 fewer ED visits.

“我们成功的合作伙伴利用了临床医生和分析人员的优势。该团队被授权建立和增强分析工具，以支持最脆弱的患者，减少不必要的使用和减少医疗支出超过3200万美元。”

Rhiannon Harms, Executive Director Strategic Analytics, UnityPoint Health

WHAT’S NEXT

UnityPoint Health will continue its efforts to enhance and refine the care management program and plans to expand the use of AI and analytics to improve the care provided to its most vulnerable patients, improving outcomes while reducing unnecessary healthcare utilization and costs.

REFERENCES

1. Health and Economic Costs of Chronic Diseases. (2021).Centers for Disease Control and Prevention.Retrieved fromhttps://www.cdc.gov/chronicdisease/about/costs/index.htm#ref1
2. Care Coordination. (2018).Agency for Healthcare Research and Quality. Retrieved fromhttps://www.ahrq.gov/ncepcr/care/coordination.html

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