D2Hawkeye (now Verisk Health)

Description | Challenge | Solution | Outcomes

Description

The University of South Alabama participates in Medicaid’s “Patient First Program” and is responsible for developing a state-wide home monitoring program for patients with chronic disease. To accomplish this goal, they need to identify the high-risk and emerging high-risk members within the population, and stratify that risk in order to focus resources upon those who would benefit most from the home monitoring program.

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Challenge

Medical care of our sickest patients is increasingly fragmented among many specialists who do not communicate with each other. This lack of data sharing creates particularly severe problems for Medicaid recipients, and for the public health care finance system. Without easily accessible information it is impossible to manage either the medical or financial risk, for individuals, or for the whole population.

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Solution

D2Hawkeye integrated the medical claims, pharmacy claims and eligibility data for all 63,000 Medicaid recipients in the dataset within 30 days. This integrated data gave the Center for Strategic Health Innovation at the University of South Alabama access to a web-based application providing:

• a predictive model that identified the subset population of 18,000 highest-risk patients
  
• risk stratification, by chronic condition, for each targeted disease
  
• a Virtual Medical Record (VMR) for each patient, which provides a longitudinal record of all claims activity over a two year period – including prescriptions, prescription strengths, and refills.
  

Using D2Hawkeye’s integrated dataset, the University is implementing its disease management program for the 18,000 identified high-risk or emerging high-risk Medicaid recipients.

In addition, the Alabama Center has identified an opportunity to provide physicians who treat Medicaid patients direct access to D2Hawkeye’s integrated data. Such access allows these physicians to view their patients’ Virtual Medical Records and to have a complete medical visit and prescription drug history, thereby eliminating duplication of services, and reducing unnecessary or inappropriate services or prescription drugs. The Center is currently presenting this plan to CMS for approval.

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Outcomes

D2Hawkeye has been instrumental in successfully identifying the highest risk subgroup of 18,000 individuals among the 63,000 Medicaid patients in the program. Based on this system, the Center for Strategic Health Innovation is currently delivering highly focused disease management and case management services, and expects to report improved medical outcomes and reduced costs in 2006.