Unlock “The Hidden Opportunities” from your Care Management Program using Vitreos™ savings calculator | Unlock “The Hidden Opportunities” from your Care Management Program using Vitreos™ savings calculator | Scoop.it

Unlock “The Hidden Opportunities” from your Care Management Program using Vitreos™ savings calculator

By Jay Reddy


A significant number of healthcare providers, payers and government agencies in United States have started adopting Population Health Management.

But providing quality healthcare at lower cost has many challenges for the providers. The challenges include:

Inability to identify at-risk risk cohort of population dynamically by factoring in both clinical and non-clinical risk factorsFrustration about not having credible population risk and care management analytics to drive effective population health management programsInability to proactively monitor/measure the true PMPM impact of your care management and managed care programs to enhance quality and financial performance


VitreosHealth® recently conducted a study using EMR, claims, and demographics data with 11,000 Medical Home populations to calculate the clinical state-of-health (SOH) score and utilization (PMPM) cost. Both acute, ambulatory, post rehab, and skilled nursing facility are included in PMPM cost.

PMPM cost and risk score are two criteria for population segmentation. The clinical risk score is the combination of individual disease risk scores (Diabetes, CHF, CHD, Asthma, Osteoporosis, etc.) and is calculated from EMR (clinical) data that includes vitals and lab information.



The top right quadrant (“Critical”) represents the group of high cost, high clinical risk patients. The lower right quadrant (“High Utilizers”) represents the group of patients that are high utilizers even though they have lower clinical risk according to their state-of-health analysis using EMR data. In most population and disease management programs, these two segments are typically identified as ‘high risk candidates’ for care management programs through claim analysis.

However, the upper left (“Hidden Category”) represents the most important patients who are in clinically higher risk today based on the EMR data analysis. But historically, they are not high utilizers, and as a result they are not identified by claim-based risk scores. The claim based risk scores are biased towards historical utilization costs. Study shows that in every year, 15-20% patients will move from Hidden Opportunity to Critical and will contribute 40-45% of total cost.

A typical Medicare population of approximately 10,000 members would see an increase of $18-$20 MM due to population migration from Hidden to Critical category in a year. Vitreos can help you in identifying migratory population segment, 12-18 months in advance, which in turn would reduce the cost by $6-$7 MM.

You can identify potential savings opportunities for the population segment you are taking risk for, by using Vitreos Savings Calculator.

Click http://vitreoshealth.com/savingscalculatoronepage/ to calculate your potential savings.

Via Vitreos Health