Insurer taps AI provider for help with population health management

Jeff Rowe
According to the Virginia-based health plan, tests of the new program logged a 64 percent success rate in determining if a patient’s costs would rise.

While AI is rapidly being integrated into healthcare sectors such as imagine and clinical diagnostics, health insurers are also wasting no time putting it to use to develop insights into broader swaths of the population.

To that end, Optima Health, health plan arm of integrated health system Sentara Healthcare,  recently announced an alliance with Cardinal Analytx Solutuions, an AI-enabled health insights company, to help them deliver more proactive care to Optima Health members throughout Virginia.

According to company officials, armed with Cardinal Analytx's new predictive capabilities, Optima Health will be able to provide increasingly proactive support to both members and patients by allowing them to identify, in real time, individuals who are at a rising risk of health decline. The Optima Health clinical teams can then proactively reach out to these rising-risk members and match them with interventions to improve their health.

For instance, John Coughlin, Optima vice president for informatics and analytics, recently explained, a patient might have issues with their weight, or smoke. With that data, the Cardinal Analytx algorithm might flag the patient as pre-diabetic, notifying Optima to help them enroll in a program to help mitigate that diagnosis. Even though the patient isn’t racking up big medical bills yet, the software still recognizes their potential heath risk.

"As part of a consumer-focused integrated health system, we believe Optima Health must be at the forefront of healthcare transformation,” Coughlin said in a statement accompanying the announcement. “Our partnership with Cardinal Analytx extends this leadership, enabling us to fundamentally change how we deliver healthcare and truly begin solving for population health.”

According to Cardinal Analytx, unlike solutions focused exclusively on members who are already experiencing high costs, their solution takes a more modern, proactive approach. By applying machine learning to the challenge of finding members of a population most likely to experience health decline, Cardinal Analytx offers Optima Health the ability to intervene before an individual enters the downward spiral of worsening health and rising cost. Cardinal Analytx then combines these AI-enabled predictions with an assessment of the individual's clinical likelihood of engagement, which will give Optima Health the best chance to proactively support the people it serves.

"The Optima Health vision for integrated healthcare aligns nicely with our mission to shift care from a reactive approach to a more proactive model,” Cardinal Analytx CEO Linda T. Hand explained. “Engaging members earlier 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.”