PreAcute PHM, Inc. is a fully HIPAA Compliant Predictive Analytics Software company which helps lower healthcare expenditures while improving its quality by use of Population Health Management (PHM) techniques. We focus on “Pre-Acute” clinical interventions because patients in this stage of their illnesses are still relatively healthy and multiple alternative, non-aggressive treatments may be available to them to head-off surgeries and other major treatments in the future. This will also help patients avoid considerable amounts of pain and suffering, as well as a risk of death, by virtue of our pre-acute intervention.
Such improvement in healthcare services is essential for implementing Value Based Purchasing. After the year 2018, all healthcare organizations will be required to demonstrate lower cost and higher quality of care. Thus Population Health Management services, such as ours, will become an essential part of future healthcare delivery.
Many modern organizations, such as Accountable Care Organizations (ACOs), as well as traditional Insurance Companies, TPAs, Self Insured-Employers, Public & Private Exchanges, etc. can already benefit from these service.
Because of our emphasis on pre-acute interventions, we take Population Health Management beyond the conventional tracking and management of chronic patients and into a new generation approach of early stage management of many other common diseases by delivering advanced custom care to more patients with more varied disease conditions. This increases the reduction of expenditure further. But this is not just about expenditure; it is also about patients, and providing improved clinical outcomes and quality of life. Our Predictive Data Analytics Solutions and associated clinical management protocols:
- Identify early onset of serious diseases in members of a population which may lead to frequent, expensive surgeries or other major treatments in the future; and
- Facilitate appropriate clinical interventions to the afflicted members in order to arrest the progression of the diseases, treat them early and inexpensively – often for better long term results, and move them off surgical or other major clinical intervention paths.
In order to address general concerns about deploying any new solutions, ours are designed to be transparent to your internal IT structure, require practically no new capital investments, and avoid any need to retrain your workforce. But most of all, they are not designed to take over your Care Management process; rather, they are designed only to assist, not automate your clinical decision making process. However, when directed by you, our solutions can also be transparently integrated with your overall Care Management and reporting systems.
The unalterable trend of healthcare moving toward from “Volume” based to “Value” based care has changed the landscape of healthcare management & delivery in the United States. The most important change has been the emergence of several new reimbursement models and the proposed Cadillac Tax. The majority of these reimbursement models require healthcare facilities to substantially reduce operating costs without compromising the quality of care delivery in order to maintain their profitability. While not all healthcare costs can be eliminated, there are significant opportunities to reduce costs in specific areas, without lowering the quality of clinical care.
The solution for profitable navigation through the rapidly changing reimbursement scenarios of today is to continuously find newer ways to increase the reduction of expenditure wherever possible. But this is not just about expenditure; it is also about patients, and providing improved clinical outcomes and the best possible qualities of life. PreAcute PHM, Inc. focuses on areas of healthcare where there are not only large expenses, but also significant opportunities for savings without lowering the quality of care provided. Unless both of these conditions are present simultaneously, viable cost saving & better outcome solutions can not be crafted. Our initial products and solutions help create savings opportunities for our clients in two such areas: “Surgeries” & “Chronic Pain”. “Surgeries” is the number one expense area of healthcare. Considering the costs of hospitalization, drugs, rehabilitation, and all the reimbursements for the surgical team, “Surgeries” as a group account for 30 to 33% of all healthcare costs. The following graph illustrates this statistics.
The above illustration graphs data from the year 2011. It is to be noted the expenditure proportions within healthcare has not changed significantly through the years and even decades. Historical data proves that 30% of all surgeries are considering “clinically unnecessary” and eliminating them offers significant opportunities for savings without compromising the quality of care (www.ncbi.nlm.gov/pubmed/266237). This trend appears to be continuing, at least through the year 2016. The following two of many such articles address this issue:
Considering the above, it is clear that there is an opportunity to save about a third of a third of ALL HEALTHCARE COSTS IN THE US, or about 10% of all costs, by eliminating unnecessary surgeries. That is an opportunity to save (about 10% of $2.9 trillion expenditure in 2016) between $200 – $300 billion in unnecessary surgery costs from the US Healthcare system.
This is the reason why PreAcute PHM, Inc. has selected “Surgeries” as an area of cost saving to focus on by applying pre-acute population health management techniques.
The next most expensive area of expenditure in healthcare is “Chronic Pain”.
Chronic Pain is also often associated with Depression, either as a result of it, or causing it.
Much of the unnecessary cost of treating Chronic Pain is encountered while trying to accurately diagnose the source of the pain and then accurately selecting the appropriate course of treatment to offer results in the best possible outcome for the patient – both tasks being relatively difficult for physicians not specialized in treating Chronic Pain. Considering the above, it can be calculated that about $173 billion of unnecessary treatment costs can be eliminated from the US healthcare system by better management of the disease.
AnaVis™ and EarlyManage™ – our fully HIPAA compliant predictive analytics software tools are designed to use clinical data where and as available from claims, pharmacy & drug utilization, EMR, Risk Assessment and Socio Economic, and other relevant databases, to first help our customers identify patients who are at-risk of needing major clinical intervention in the near future (AnaVis™) and then provide advisory services in the selection of appropriate treatments (EarlyManage™). The minimum data set we need in order to make useful predictions, is Clinical Claims data. If the above tools are used to implement a comprehensive Population Health Management program, it will extend the traditional outreach to go well beyond the present day practices of focusing on chronic disease patients and deliver advanced custom care to more patients with more varied disease conditions and increase the reduction of expenditure further. It will help improve reimbursements under Value Based Purchasing, and better support Shared Savings. The lowered expenses will also help Private as well as Public Exchanges navigate their clients around the danger of Cadillac Tax penalties.