Advocate Aurora Health is using predictive analytics to target outpatients who have a heightened risk of unnecessary hospitalization.
Using claims data alone doesn't work because of the lag time, said Tina Esposito, system vice president and chief health information officer.
"By the time we've identified patients as high risk, the event has happened," she said.
Instead, Advocate Aurora Health's predictive modeling platform uses 30 to 40 sources of claims data that is integrated with EHR data.
"In some respects, this is a beautiful marriage between data and business," Esposito said. "We've partnered very heavily with the outpatient care managers."
The system's outpatient care management program offers a paradigm shift in traditional care management, according to Senior Clinical Process Designer Fran Wilk.
"This is an assertive format," Wilk said. "We use specific tools. A lot has to do with support and care management."
The model identifies patients at a heightened risk for an acute encounter. Care managers are then paired with patients to teach them health maintenance, to become engaged and to self-manage their conditions.
"We're engaging patients to change behaviors, such as weighing themselves daily," Wilk said.
With over a million attributed lives in an accountable care organization, Advocate Aurora Health has a stake in ensuring the right care is targeted to the right patients. The ACO is not at full risk.
The model has yielded a significant reduction in readmissions and improved the health of a population, according to Wilk and Esposito.
"Early indications are a pretty significant reduction in spend," Wilk said.
Out of an estimated 350 patients, about half have reached the maximum benefit.
The health system has tested a pilot program with heart failure patients who are at high risk for unnecessary utilization. The result has been a 23 percent reduction in hospitalization, ER use and observational stays for heart patients.
The large integrated health system of 27 hospitals was created in 2018 by the merger of Advocate Health Care and Aurora Health Care.
Esposito and Wilk are scheduled to present during the HIMSS19 session, "Utilizing predictive analytics to increase the value of care." It's scheduled for 11:30 a.m. to 12:30 p.m. Thursday, February 14, in Room W314B.
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