Accurate analysis of individual members and populations enables
payers to identify those most at risk for chronic diseases and to
more appropriately devise and deploy care management resources.
This results in greater operational effectiveness, clinical
consistency, reduced waste and, ultimately, better care and
stabilized costs.
Alineo Care Management Analytics is a powerful, yet simplified,
tool that enables payers to identify and stratify individual
members and populations and then establish optimal intervention
levels and more focused care improvement plans. It includes Medical
Episode Grouper® (MEG), an industry-standard methodology from
Thomson Healthcare, and predictive modeling intelligence from
Verisk Health. It works in conjunction with Alineo Clinical
Intelligence, a component comprised of rules developed from
evidence-based medicine, reference materials, industry-standard
best practices and physician expertise to ensure clinical
consistency in the care management process. Together, the two
components help ensure that patient data and related treatment
opportunities are routed through the proper workflows and delivered
to the appropriate case manager for more effective care plan
development and patient intervention.
In addition, Alineo Care Management Analytics offers an open and
extensible design for maximum adaptability. It is capable of
integrating with a wide array of technical systems and solutions
and can be customized to meet the specific needs of individual
organizations.
For case management, Alineo Care Management Analytics allows
payers to identify patients who:
- Are not in a care management program but could benefit from
one, and/or are expected to need one within six to 12
months.
- Are missing key quality measures in their treatment plans.
- Are receiving questionable treatment.
- Are costly.
For disease management, Alineo Care Management Analytics helps
payers identify:
- Cost drivers within diseases.
- The services being over- or underutilized in those
conditions.
- The patients being treated in those conditions.
- Those patients who may develop complications of targeted
diseases.
Other benefits of Alineo Care Management Analytics:
- Furnishes providers and care managers with a concise care
history on which to evaluate enrollees.
- Assists providers in ongoing efforts to achieve better
outcomes.
- Improves member relations.
- Documents process improvement strategies for patient care.
- Aids in resource planning.