Optima Health applies AI to ‘rising risk’ pop health

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Optima Health and Cardinal Analytx Solutions have announced a new partnership to benefit Optima’s members in Virginia in the “rising risk” category.

Palo Alto, Calif.-based Cardinal Analytx’s AI-enabled predictive analytics will help Optima to proactively address members with health risks that, if left unmonitored and untreated, could move up to the highest risk and highest cost category.

Cardinal Analytx combines AI-enabled predictions with an assessment of a member’s clinical impactibility and likelihood of engagement, which gives health plans like Optima the best chance to proactively support the people it serves, Cardinal says.

According to Linda Hand, CEO of Cardinal Analytx, engaging members earlier in a more proactive way enables them to live healthier lives and reduces costs for both individuals and plans.

"Together, Cardinal Analytx and Optima Health can truly see around the corner, bringing tomorrow's risk and rising cost into focus through the same lens for the first time,” she says. “With this clearer, more complete view, Optima Health can guide members to better care, sooner."

John Coughlin, vice president of informatics and analytics at Optima Health, the health arm of Sentara Healthcare, which provides health insurance coverage to more than 510,000 members, says the move to partner with Cardinal Analytix is part of a consumer-focused strategy to lead a transformation in healthcare.

“Our partnership with Cardinal Analytx extends this leadership, enabling us to fundamentally change how we deliver healthcare and truly begin solving for population health," Coughlin says. "Given that Cardinal Analytx's offering was better at identifying rising-risk members than our existing approach, we are tremendously excited to leverage this solution at scale.”

Under current risk-based payment models, health plans are being forced to become population health management companies, says Wolf Shlagman, CEO and founder Care Angel, a population health management company. However, few plans are focusing on the rising-risk group, despite statistical evidence that 20 percent of the patients in this group will move up.

Focusing on high-risk populations is nothing new, says the Blue Shield of California Foundation, sponsors of a white paper entitled, “Rising Risk: An Overview of Identification and Intervention Approaches,” based on research conducted by JSI Research and Training Institute Inc.

For the paper, JSI explores rising risk through a literature study and interviews with healthcare leaders, concluding that there is an emerging interest in addressing the needs of the rising-risk group—"in part as a predictable follow-up to efforts to improve outcomes and reduce costs among high-utilizing populations.”

The researchers also say there is a “great need” for more studies on how health plans can assist the rising-risk population in achieving better health.

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