Measuring Impactability- A Game Changer in the Management of High Risk Members – A Blue Cross Blue Shield of Louisiana Pilot

Author(s)

Zhang Y, Zhang R, Liu M, Diller T, Nikolaus K, Chaisson J, Bailey C, Bergeron T, Ouyang J, Cantrell D, Vicidomina B, Nigam S
Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA

OBJECTIVES : Health plans try and predict the less than 1% of their members who will need extra support in order to maintain their health status by avoiding hospitalizations and emergency department visits. In addition to identifying high risk members, members are further stratified to match with the most appropriate interventions at the best timing in order to impact behavior and mitigate risk through 'Impactability Score'.

METHODS : BCBSLA impactability score was developed by front line care management nurses, primary care physicians and medical directors and the use of machine learning algorithms with over 8,000 data elements. Clinical data were organized into care opportunities, and then care opportunities were combined with risk scores, social determinants, program evaluation results, and clinical feedback to create the impactability score for each intervention approach, made available to healthcare providers and BCBSLA case managers via a dashboard. Currently, three intervention approaches were considered, telephonic care management program, community care management program, and primary care physician engagement program.

RESULTS : Preliminary results show that intervention programs are increasing their engagement and reducing future claim cost. For example, a member that is over the age of 80 with end stage renal disease in hospice care is a high risk member; but his or her health status is not really impactable through telephonic disease management program; whereas, a patient newly diagnosed with cancer with 4 open care gaps is also a high risk patient, but his or her impactability factor is high. There are care management programs that can be offered to mitigate this patient’s risk while reducing costs.

CONCLUSIONS : The impactability score allows BCBSLA the ability to evaluate a patient’s likelihood of benefitting from a particular intervention which in turn directs providers/care management nurses to the right member, at the right time, through the most appropriate intervention approach maximizing care and reducing costs.

Conference/Value in Health Info

2021-05, ISPOR 2021, Montreal, Canada

Value in Health, Volume 24, Issue 5, S1 (May 2021)

Code

PMU40

Topic

Health Policy & Regulatory, Health Service Delivery & Process of Care, Methodological & Statistical Research, Patient-Centered Research

Topic Subcategory

Artificial Intelligence, Machine Learning, Predictive Analytics, Disease Management, Insurance Systems & National Health Care, Patient Engagement

Disease

Multiple Diseases

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