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BOSTON – Predictive modeling (PM) is no longer a nascent market, with PM-strategy conferences being organized, more sophisticated RFPs being sent out and more interest among health plans.
Yet, PM tools must heed health plans' call for ROI, quantitative and qualitative, and PM vendors are grappling with how to address those issues.
Jocelyn Young, research director for healthcare technology for New York-based Datamonitor, said that PM is a piece of the puzzle for identifying high-risk patients and matching their needs to health plan programs.
"But to remove some of the reticence with health plans, vendors need to set up a framework for ROI to be effectively measured," Young said.
PM vendors are at odds with how to measure ROI, as well as its importance.
Marilyn Schlein Kramer, CEO of Boston-based DxCG, which was acquired by Jersey City, N.J.-based property and casualty business data firm ISO in May, said that DxCG saves money for clients with better workflows for both financial and disease management (DM).
According to Kramer, the savings ratio for clients averages anywhere between $17 to $85 for every $1 spent on DxCG.
On the disease-management side, DxCG's tool has helped decrease the number of inappropriate cases by 30 percent and identified 2,000 cases that were not originally referred to DM programs.
Michael Cousins, vice president of health informatics for Richmond, Va.-based Health Management Corporation, said, "Health plans should focus on where they should be directing clinical resources, which members are adhering to guidelines and how many are not. These are real clinical indicators that disease-management programs are working."
"Predictive modeling must be integratable with intervention, and disease-management programs need to look for ways of closing the gap for guidelines," Cousins said.
Dogu Celebi, vice president of medical affairs for Waltham, Mass.-based Integrated Healthcare Information Services, said that PM tools target patients who are more suitable for intervention, but added that to make a difference in people's lives, health plans must have effective disease- and care-management programs in place.
