More Than Just Predictive Modeling

PredictiveCARE gives you better visibility to make the best medical management decisions for your population. How does PredictiveCARE do that? With feature rich applications that give you the ability to aggregate health care data from the member level up. One click gives you access to a virtual medical record for every enrolled individual — a complete history of all medical and pharmaceutical claims.

The PredictiveCARE program uses a software application that has more than three hundred Quality and Risk Measures which are applied to every health care history, yielding an Adjusted Risk Index that can give you early warning of situations where more intensive medical management may be justified.

This Predictive Modeling capability has a strong foundation in the art and science of medicine, from which rules-based logic is derived and used to analyze the detail-rich data sets of the individual and aggregated member health care histories.

With PredictiveCARE, you will have instant access to reports and analysis showing your population trends and ultimately drilling down further to discover underlying causes to understand the "why" behind your high-risk members.

What Can PredictiveCARE Do For You?

The PredictiveCARE Method

CareNet’s PredictiveCARE applications sets up data import and data scrub engines, both customized to your system. Your eligibility, claims and pharmacy data (and lab data, if available) are imported and “scrubbed” on a monthly basis, and are stored in your own dedicated data warehouse -- ready for you to mine for knowledge.

Implementations for new clients usually occur in less than 90 days

Turning Data into Actionable Knowledge

CareNet’s PredictiveCARE program is designed to optimize medical management. It evaluates quality of care provided, and contributes to an individual's Adjusted Risk Index (a component of our predictive model). This incredible measurement tool that has thousands of hours invested in its creation was developed and is continuously updated by the D2 Medical Group.

The analytical results reflect the latest thinking on evidence-based medicine and standards of care, as well as proprietary predictive measures developed by the D2 Medical Group. Parameters used in the medical rules library include more than 50,000 relative risk measurements, encompassing 18,000 medical and 5,000 surgical diagnosis codes, 10,000 procedure codes, and 24,000 Rx NDC codes. Members non-compliant to quality measures are considered riskier, resulting in an Adjusted Risk Index (ARI) higher than the unadjusted Risk Index (RI).

How It Works

All members are assigned a Risk Index, based on their health histories. Hundreds of Quality and Risk Measures are applied to the Risk Index to yield an Adjusted Risk Index. For example, members who are not compliant with quality measures are considered riskier, and are assigned a higher multiplier, yielding a higher Adjusted Risk Index.

In this way, members are stratified on their medical condition, their adherence to quality measures, and the quality of care delivered to them. The system identifies at a glance those members who are likely to be the most costly next year, thus opening up opportunities for care management.

Virtual Medical Record

As an integrated tool for the delivery of quality care, PredictiveCARE aggregates health care data from the member level up. One click will give you access to a virtual medical record for every enrolled individual. This virtual medical record shows a complete history of all medical and pharmaceutical claims, from all providers, no matter how fragmented the data.

This longitudinal view of every member's medical history is instantly accessible by care managers, opening up a new world of coordination of services and potential for true preventive care.

Intervention

Using CareNet’s NurseCARE triage program in conjunction with Predictive Modeling Tools can help you maintain your population’s healthcare needs.Combining NurseCARE’s triage component gives you an additional monitoring and measurement tool that allows consistent care support by informing and educating patients on their condition, empowering them to be proactive in their own health management, and inspiring each person to make the right choices regarding lifestyle changes.

Reporting

Get the correct analytical overview to support the right decision with PredictiveCARE’s complete reporting solution.

D2Hawkeye Explorer is a complete reporting solution. Almost every screen view in the product can be exported to Excel for easy reporting, manipulation and graphing. The product also includes standard medical and financial reports, providing in-depth analyses of the medical issues and cost drivers that may affect spending. Finally, our expert engineers will help you to design a customized report to fit your particular needs.

Sample components of PredictiveCARE’s reporting engine include: