Identifying the right members for case management can make or break a case management program. For these programs to be successful and yield sustainable, positive returns on investment, it is critical to identify members who would benefit most from the program: members whose risk and engagement trajectory best match the services offered by case management services.
Decision Point’s supports both field and traditional case management activities with independent member identification algorithms that proactively evaluate members based on their clinical, behavioral and engagement risk.
For field case management, Decision Point identifies members with a high probability of avoidable, high-intensity resource use, high probability of functional status decline and low predicted provider engagement. These members would benefit most from home-based case management resources. For traditional case management, it is simply not enough to predict members who are predicted to have the highest cost: Decision Point predicts members that are predicted to have an undesirable disease trajectory, predicted to be actionable, and predicted to be high clinical risk.
Decision Point’s approach is unique: we provide solutions which help ensure timely care matches an individual’s actual needs with available programs and resources. We do this by rapidly identifying the health care profiles and needs of individuals, matching those needs with available resources and care improvement programs, and providing tools to track, manage and evaluate the care provided to these individuals. In short, we ensure that the right individuals are targeted for the right care at the right time.
Results & Outcomes
Decision Point’s Medicare approach produces results. Our clients:
Reduce hospital readmissions for Medicare members:
- Our models have identified more than 70% of readmissions by targeting less than 5% of members, and reduced readmissions by 25% annually;
Reduce hospital admissions for Medicaid members:
- Our models lowered hospital admission rates by 5%-15% annually, depending on the condition
Reduce ER visits for Medicaid and Exchange members:
- Our solution lowered emergency room visits by 5% – 12% annually
Contact Decision Point today to learn more.