Briefs

May 2004: Tech and Tenderness - TPA uses predictive modeling based on artificial intelligence, wrapped with personalized nurse intervention, to lead high-risk patients to medical care. By Robin Blair. Health Management Technology.

... DM stands not only for data mining, but also for Disease management. The DM concept, of course, made perfect sense in the beginning: Manage those patients with chronic, high-cost conditions to avert admissions or emergency episodes and, hence, reduce costs. But how does a health plan with 500,000 members actively influence 10 percent of its membership with diabetes, congestive heart failure and asthma in such a way that the intervention moderates behavior that, in turn, moderates costs? That�s 50,000 people and a lot of intervention. How much smarter might it be to predict who could be in the high-risk population years before they get there, and modify their behavior now?

The advent of more sophisticated predictive modeling technology has turned attention to high-risk health plan members who aren�t yet high-cost patients, but soon will be without effective intervention and lifestyle changes. These may be patients in the early throes of utilization, as well as consumers who aren�t yet active utilizers. Experts postulate that 2 percent of a health plan�s membership may be at very high risk and may, eventually, drive 70, 80 or even 90 percent of the health plan�s expenses. Those numbers alone make it a problem worthy of the IT microscope.

The technology foundation of High Impact is Risk Navigator Clinical, a forecasting tool from Orlando, Fla.-based MEDai (Medical Artificial Intelligence). The technology foundation of Risk Navigator Clinical is MITCH (Multiple Intelligent Tasking Computer Heuristics), a prediction engine that allows health plans and TPAs to not only predict which members are tomorrow�s high-cost patients, even if they are not now heavy utilizers, but also to predict which individuals in the high-risk population are likely to respond to intervention. MEDai CEO and co-founder Steve Epstein says the technology is third-generation. It started with rules-based systems, he says, then progressed to groupers, and now systems are heuristic. They have become 'smart'.

Here is the rest of the story from Health Management Technology.