Lovelace Health Plan chooses Elsevier/MEDai predictive analytic solutions

Thu, 04/14/2011 - 11:38am

Orlando, Fla. 14 April, 2011 Elsevier / MEDai, a leading health information company with award-winning solutions for the improvement of care delivery, announced today that Lovelace Health Plan in New Mexico has purchased several products in MEDai's suite of Risk Navigator products to drive quality outcomes through predictive analytics. Lovelace will use Risk Navigator Clinical®, Risk Navigator Performance® and Risk Navigator Financial®.

Lovelace chose the suite of Risk Navigator products because of its ease of use, reliability and transparency of risk predictions, integration of evidence-based medicine guidelines, and the speed and thoroughness of implementation.

"We were in need of a solution that allowed us to reliably forecast healthcare costs, identify and stratify risk in our patient populations, identify which patients would be positively impacted by our case and disease management programs, and enhance the patient/provider experience," said John Cruickshank, chief medical officer, Lovelace Health Plan. "The suite of Risk Navigator products we have selected will allow us to focus on member and clinician engagement, enhance communication, continually measure and improve quality of care, and manage costs."

Risk Navigator Clinical applies evidence-based clinical rule sets and advanced mathematical process to claims, membership and other data to identify high-risk members. Lovelace will utilize Risk Navigator Clinical to improve its population risk and member disease management. At the population level, Lovelace will better understand what conditions are driving costs within the health plan and what the risk profile is of the population as a whole. At the member level, it will be utilized to show how to manage high-risk conditions (i.e. diabetes, asthma, coronary artery disease, etc.). Clinicians and administrators can then use these clinically based forecasts to allocate resources efficiently and intervene before adverse outcomes occur and unnecessary dollars are spent.

Lovelace will also use Risk Navigator Clinical to improve engagement with clinicians by giving them access to member history and compliance information. Risk Navigator Clinical will allow clinicians to see a member's compliance with evidence-based medicine guidelines. If a clinician receives a report that shows his patients have a 50% compliance rate, that clinician now has the ability to engage with his patients based on the information provided by Lovelace and potentially improve outcomes for that patient.

Risk Navigator Performance provides retrospective and prospective profiling of providers and facilities, and compares provider and facility performance against national and regional benchmarks. Lovelace will use Risk Navigator Performance to view provider profiles internally by focusing on quality and evidence-based medicine guideline compliance rates.

Risk Navigator Financial supports actuarial and underwriting analysis and reporting by leveraging clinical risk information and cost predictions. Risk Navigator Financial will allow Lovelace to better identify and assess the risk associated with an employer group at the time of renewal. Additionally, Lovelace will be able to look at the risk assessment by categories of eligibility for its Medicaid population.

"Health systems are faced with the task to ensure a high quality of care while also managing costs," said Clayton Ramsey, chief operating officer, Elsevier / MEDai. "MEDai's predictive analytic tools will allow Lovelace to identify costly populations, assess risk and improve provider information sharing ultimately improving quality outcomes and lowering healthcare costs."




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