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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Workplace programs, policies and environmental supports to prevent cardiovascular disease


By Truven Staff/Tuesday, February 7, 2017

Ninety-nine percent of the U.S. population has at least one of seven cardiovascular health risks: high blood pressure, high total cholesterol, high blood glucose, unhealthy body mass index (BMI), tobacco use, physical inactivity, or poor diet.[1] The combined contribution of these risk factors increases employer medical spending by 213 percent per person per year.[2]

“Organizations need to assess their heart health programs, policies and environmental supports to reduce health risk factors for cardiovascular disease, lower the prevalence of the illness, and reduce medical expenditures,” said Ron Z. Goetzel, Ph.D., vice president of consulting and applied research at Truven Health Analytics, an IBM Company.

The American Heart Association (AHA) offers the Workplace Health Achievement Index (WHAI) to help organizations perform these assessments. Last year we connected organizational WHAI measures to individual employee medical, drug and health risk data housed in the Truven Health MarketScan® multi-employer database, and together we analyzed the data.

Results from the study

Twenty large employers participated in this study to assess the association between organizational health and measures of cardiovascular health risks, disease prevalence and medical costs. Some results of the study included:

  • One fifth of employees have cardiovascular disease, with an average per member per year spending of $329 for the disease
  • The most common health risk for these workers was unhealthy weight (72% prevalence), followed by poor diet (71%) and high blood pressure (66%)
  • The least common health risk was tobacco use (5.5%), which was substantially lower than that for the U.S. adult population (16.8%)
  • A higher WHAI score was associated with lower prevalence of four modifiable health risk factors: high blood pressure, high cholesterol, tobacco use, and physical inactivity
  • WHAI scores were not correlated with high blood glucose and unhealthy weight, but were positively correlated with poor diet
  • A higher WHAI score was associated with lower cardiovascular disease prevalence but higher cardiovascular disease spending, a result meriting further study

Though there is no clear pattern as to which organizational health factors are associated with better outcomes, we encourage employers to participate in the next wave of multi-employer studies that aims to look at trends in organizational programs, policies and environment, and how these support a healthy lifestyle among workers[SE1] [GRZ2] .

What can employers do with these results?

  • Employers can act now! There is no need to wait for more research before implementing evidence-based health promotion programs proven to positively influence employee health and well-being.
  • When implementing a program, remember to always measure and evaluate.  This can be done by designing “dashboards” that track key program structure, process and outcome measures for the organization.
  • Finally, employers can experiment with different health promotion strategies at different business units/locations and track the effectiveness of alternative models.

Dr. Goetzel presented the study findings at a briefing event sponsored by Health Affairs on Tuesday, February 7, 2017 at the National Press Club in Washington, DC.  For more information, click here.

 

[1] Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation. 2012;125:987-995.

[2] Goetzel RZ, Pei X, Tabrizi MJ, Henke RM, Kowlessar N, Nelson CF, et al. Ten modifiable health risk factors are linked to more than one-fifth of employer-employee health care spending. Health Aff (Millwood). 2012;31(11):2474-84

 

 

 


Risk of Hospitalization


By Therese Gorski/Tuesday, December 13, 2016

As Anne Fischer wrote in her last blog How a Data Scientist Thinks about Risk Stratification, in order to predict risk, we need to first determine what “risk” is being measured. One important risk is that of being hospitalized.  Risk of hospitalization or admission models have become more targeted, more personal and seemingly more prevalent. Further, they are very much in line with the goals of population health and the “quadruple aim” (improving patient care, reducing costs, improving the health of populations and improving the provider’s experience). If a person has proper ambulatory or outpatient care for a chronic disease, acute inpatient admissions related to that disease should be rare.

At Truven Health, we have been developing and maintaining risk models for decades. Many risk models, such as risk of cost, risk of mortality and risk of complications, are best used in aggregate within a population subset. This evaluation is typically done at a service line or patient group level, for example, all cardiovascular patients or all patients with a specific MS-DRG.

In today’s world of increasing interest in care management and targeted outreach, individual level risk models hold much promise.  These models evaluate and interpret risk for each individual patient. Several years ago, we started a journey to develop new targeted risk models – including risk of hospitalization – to meet this increasing business need. We focused on specific diseases with the intent to have high predictive accuracy overall but particularly at the “tails”, meaning we must perform well at identifying those who have a high likelihood of being admitted in the near future. Or, in data science terms, model performance was measured by its sensitivity, specificity and positive predictive value for all patients above a specific risk threshold, with an emphasis on high sensitivity (that is, reducing false negatives).

To start, we chose to focus on diabetes, congestive heart failure (CHF), asthma, and more recently chronic obstructive pulmonary disease (COPD). These conditions run the gamut for both prevalence and admission risk, with asthma being most prevalent and least likely to result in admission versus CHF, which is least common but most likely to result in admission. These are also chronic conditions that are typically managed, at some level, which also fit our criteria.

In addition to specific diseases, we also focused on identifying risk at one-, three- and six-month intervals so that a care manager can better understand the risk at hand and be able to prioritize accordingly. Further, we report risk across several categories including “all-cause admissions”, “potentially avoidable admissions” (largely defined by AHRQ) and risk of “related admissions” which represents conditions that are considered to be related to the main condition as defined by Truven Health. Finally, along with each model’s risk score, we provide the patient attributes that are driving the risk score, whether it be a recent hospitalization, level of disease severity or even age. We believe that this additional insight gives the care manager a bit more background on the patient, helping to explain why the patient may have an increased risk value.

These models have been notably successful in terms of their predictive accuracy and our work will continue as we expand the number of diseases and work with our clients to help make the information actionable. The general trend toward person specific risk versus risk in aggregate will only grow and will become more refined as we, and the industry in general, are able to obtain and incorporate more personalized information about people.

Therese Gorski
Senior Director, Advanced Analytics


Truven Health Risk Model Ranks High in Actuarial Evaluation


By John Azzolini/Monday, November 28, 2016

 

Healthcare payers today are facing the complexities of reform, increased competition, and budget constraints — all while dealing with pressures to reduce costs and improve member health. Managing health risk has become a necessity. But to manage risk, payers must first understand their population. To do this well, they need reliable, robust risk and cost of care models.

 

Last month, the Society of Actuaries (SOA) released a study showing that Truven Health Analytics’ cost of care model outperformed other risk models in 18 out of 22 measures. SOA’s Accuracy of Claims-Based Risk Scoring Models compared health risk-scoring models, building on their previous studies with similar objectives (the most recent was in 2007). In the medical claims category (predictions based only on medical claims data), the current study showed that, in 21 of the 22 measures, the Truven Health model was ranked either first or second. No other model came close to matching this performance. (See Table 1 for a summary of how Truven Health’s model ranked relative to the competition).

 

How the SOA Evaluates Risk Models

The SOA evaluated Truven Health Analytics’ cost of care model against six others:

 

  • ACG® System
  • Chronic Illness & Disability Payment System and MedicaidRx
  • DxCG Intelligence
  • HHS-HCC
  • Milliman Advanced Risk Adjusters
  • Wakely Risk Assessment Model

 

The SOA assessed all models on their ability to predict costs using the Truven Health Marketscan® commercial claims dataset of 1 million members, and used three methodologies to evaluate their precision: R-Squared, the mean absolute error statistics, and predictive ratios. All three methodologies measure the statistical difference between the prediction and the actual results. All models produced both a concurrent and prospective cost prediction and were evaluated using both a capped data set (where patient costs were capped at $250,000) and a non-capped data set.

 

The SOA evaluated the models’ predictive ability using a number of scenarios (total medical costs, simulated random groups, condition-specific predictions, patient cost). In the simulated random group scenario, the SOA created groups of 1,000 and 10,000 patients to simulate the application of the model to subgroups of the population.

 

Table 1: How the Truven Health Cost of Care Model Performed

The Truven Health model ranked first or second for its ability to predict costs in 21 of the 22 measures studied.

 

Scenario

Truven Health Model Ranking*

R-Squared

Mean Absolute Error

Non-Capped

Capped**

Non-Capped

Capped**

Total Medical Costs, Concurrent

2

1

2

1

Total Medical Costs, Prospective

1

1

1

1

Simulated Random Groups, Concurrent

2

3

1

1

Simulated Random Groups, Prospective

1

1

1

1

 

 

Predictive Ratios

 

 

Overall Condition Specific Prediction, Concurrent

 

1

 

 

Overall Condition Specific Prediction, Prospective

 

1

 

 

Very Low Cost Patients, Concurrent

 

1

 

 

Very Low Cost Patients, Prospective

 

1

 

 

Very High Cost Patients, Concurrent

 

1

 

 

Very High Cost Patients, Prospective

 

1

 

 

     * Compared with six other models.

** Capped at $250,000

 

Why Risk Models Are Important to Payers

Risk modeling is a very helpful tool for health plans and employers. It can provide valuable insights into member utilization patterns and risk– vital for benefit planning, disease management and wellness program management, and member communications. It can provide deep insights into provider performance, and aid in determining ideal reimbursement and premium rates. Such models are an integral part of a number of Truven Health databases and analytical tools. The SOA evaluation speaks to the high quality and reliability of the Truven Health solutions.

John Azzolini
Senior Consulting Scientist

How a Data Scientist Thinks about Risk Stratification


By Anne Fischer/Tuesday, October 25, 2016

“Risk”. It’s a word we hear every day in the healthcare industry. We want to avoid risk, we want to predict risk, we want to find patients that are high risk. We want to risk stratify populations (organize people into a set number of mutually exclusive tiers of increasing risk).

My recent blog posts have centered around the concept of Population Health. Clearly the idea of risk is particularly important in this world, where the goals are to keep well individuals healthy, avoid poor outcomes for those that are already sick, and minimize costs. Understanding, assessing, and predicting risk are all essential to this effort.

But what is “risk”? If you asked a physician, an insurer, and an average Joe on the street to describe “high risk” from a healthcare perspective, you would likely get very different answers. A physician might describe someone with high risk of developing a disease, high risk of a serious disease complication, or high risk of mortality. An insurer might describe someone at risk for a high amount of spending in the immediate future. The average Joe might describe someone at high risk for impairment/inability to function in daily life. Understanding the context-appropriate definition of risk is the first step toward building analytics to support risk analysis. And the appropriate definition is always dependent on the real world application.

Even when the application is understood, there is still considerable work to be done to identify the appropriate data and characteristics that lead to poor outcomes. Consider a discharge nurse who sees hundreds of patients a month as they prepare to depart from the hospital. Most knowledgeable hospital staff are aware that the most experienced discharge nurses will be able to tell you, with a high degree of accuracy, who is likely to show up back in the hospital in the near future. Multiple studies have tried to quantify the drivers of this type of “nurse’s intuition”. How do they know?

In 1964, United States Supreme Court Justice Potter Stewart used the now infamous phrase: “I know it when I see it” to describe his threshold test for obscenity in the case of Jacobellis v. Ohio. A discharge nurse might say much the same thing when asked to describe a patient at high risk for readmission. I know it when I see it. Characteristics such as illness burden, past behavior, social situation, self-care ability, home support, and others are often referred to, but the reality is that it’s the entire picture, and often a bit of an ambiguous “gut feeling” thrown in for good measure.

So how does Data Science fit into this picture? Our challenge as Data Scientists is to turn “I know it when I see it” into a measurable mathematical formula, so that everyone “knows it” even without seeing it in person. It involves extensive experimentation with different data sources, variables, and modeling techniques, as well as building in the capability for models to evolve and learn over time. At Truven Health Analytics, my team is exclusively focused on developing and testing new models, using various kinds of data that are readily available to us. In future blogs, we’ll describe some of these models including risk of developing diabetes and risk of admission. Truven Health, an IBM Company, now is positioned to move deeply into this space and develop these types of risk models by bringing together traditionally disparate data sources, clinical knowledge, and cutting edge modeling techniques.

Anne Fischer
Senior Director, Advanced Analytics


What Data Will Be Available for Population Health Analytics?

Key Questions that Data Scientists Will Ask


By Anne Fischer/Thursday, September 15, 2016

This is the third in a series of three blogs that present key questions that must be answered before developing an analytic to support the business needs of Population Health Management (PHM) stakeholders or players, including health systems, practitioners, insurance companies, employers and government agencies.

The players agree they need cutting-edge analytics to make sense of their population, and the simplest definition of Population Health Management (PHM) that seems to be accepted by all the players is: Meeting the healthcare needs of a defined population of individuals, from the healthiest to the highest risk, with the right programs at the right time to ensure the best outcomes possible. On Tuesday I described the first question, who is the population that is to be managed; on Wednesday we turned to the “so what” question, what services can be offered to facilitate the management of the population.

The third important question is what data will be available on which to build the analytics?

Commonly utilized data sources for healthcare analytics include:

  • Information created for administrative purposes (administrative data)
  • Administrative data specifically created for reimbursement (claims data)
  • Information recorded to facilitate the process of delivering care (clinical data)
  • Self-reported information, such as survey data
  • Socio-economic data, either public or privately gathered
  • Device-generated data

Two aspects of this topic are important: what data will available to build the analytic and what data will the player have ongoing access to when applying the analytic?  In the ideal world of analytics development, each method is built using a comprehensive and representative data sample. In other words, the data should have a longitudinal view into a population’s healthcare experience using various data inputs, including administrative and EHR sourced content in addition to socioeconomic details; and, it should be inclusive of all types of individuals so that it is not biased toward certain demographics.

Answering questions about a population becomes more difficult when you don’t have all of the population’s information and need to infer certain aspects. Typically, the health systems or practitioners don’t have a comprehensive view of their patient population, but “they don’t know what they don’t know”.  On the other hand, typically, the insurers or employers do not have access to the clinical richness that lives within the medical records. And while many parties are optimistic about the value of socio-economic data, the process of obtaining that data and merging it into other data sources is not insignificant.

In summary, although on the surface it may appear that the same analytic solutions are desired by all the players, it’s highly unlikely that everyone can use precisely the same analytics due to different answers to three key questions: who is the population, what services can realistically be offered, and what data will be available. The job of Truven Health therefore becomes one of designing analytics that are specific to particular use cases, but with as much flexibility as possible to allow for applicability in various business and data situations. In later posts, I’ll discuss the various types of analytics that can be created once these three key questions are answered, along with some of the specific new analytics Truven Health is developing. 

Here are links to the two prior blogs on this topic: 

Anne Fischer
Senior Director, Advanced Analytics

 


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