Using Social Determinants in a Predictive Analytics Model

  • September 22, 2016
  • 1:00 PM – 2:00 PM ET
  • Online
about

Conventional approaches to predictive analytics rely upon claims data to identify risk of medication non-adherence, emergency hospitalization, readmission, or other adverse events. However, these approaches fall short when identifying the “right” events – those events on which a significant impact can be made.

This webinar will share how to break with convention and enrich your claims data with over 10,000 personalized social determinants of health data.  The resulting analytics models target those members who would most benefit from intervention.  This approach can help plans be proactive by identifying and acting on risk before an adverse health event occurs – for example, post-acute risk up to 30 days before a hospitalization.  And these analytics identify both clinical and non-clinical risk drivers to help the care team take relevant action to reduce the risks.

Webinar participants will learn:

  • What are social determinants of health data
  • How social determinants can impact member engagement and risk
  • Which events are the “right” events to target for maximum positive impact on member health
  • How predicting the “right” events can have a positive financial impact on health plans
  • Real-world results

Who should attend: Leaders and Senior Management from Medicare, Medicaid and Commercial Plans with responsibilities in the following areas:

  • Care Coordination
  • Risk Adjustment and HCC Management
  • Star Ratings and Quality Improvement
  • HEDIS/CAHPS/HOS
  • Member Engagement and Education
  • Product Development and Plan Strategy
  • Medicare and Government Programs
  • Data Management/Performance Analytics
  • Revenue Management/Financial Performance
  • ROI and Value Assessment
  • Performance Improvement
  • Accountable Care

Speakers:


Michael Cousins mugMichael S. Cousins, President and Chief Analytics Officer, Forecast Health
Michael is co-founder of Forecast Health, a predictive analytics firm that helps health systems use analytics to grow membership, improve population health, and engage patients. He leads their risk management analytics operations and focuses on opportunity analytics for identifying and prioritizing population health initiatives, network analytics for identifying credible narrow networks, and predictive analytics for identifying “impactable” patients at high-risk of non-compliance and adverse events.

Prior to Forecast Health he was the VP of Analytics at Evolent, an ACO enablement company. He led their analytics for program evaluation, network analysis, and predictive modeling. This work supported the company’s emerging hospital-based population health programs.

Previously he was VP of US Analytics at Cigna, a health insurance and services company, where he led the analytic operations for all of the US business lines including individual/retail and employer segments, medical, ACO network, disability, dental, service operations, and pharmacy. His department’s work spanned population health and case management, patient incentives, engagement, pay for performance (P4P) and value-based benefit design, benefits navigation, ACOs and medical homes, and both vendor and provider network design.

He’s held other leadership positions, including at Optum where he built and led the medical management payer and vendor practice. Prior to that he was at Health Dialog as the VP of R&D to assist in the company’s efforts to create outcomes evaluation methods for their disease management programs, predictive modeling, and expand research based on the Dartmouth Atlas into commercial health plans.

He started his healthcare career as a biostatistician building predictive models to predict adverse events and future costs at Anthem’s disease management subsidiary called Health Management Corporation (HMC). When he left he was the VP of Informatics and Reporting and led the data management, R&D, predictive analytics, and reporting departments.

Michael’s been an invited speaker at professional meetings, such as the Society of Actuaries (SOA), and at industry conferences, such as America’s Health Insurance Plans (AHIP), National Managed Health Care Congress (NMHCC), and Population Health Alliance (PHA). His generally speaks on outcomes evaluation methodologies and the application of predictive modeling tools to identify high-risk “impactable” cases. He recently spoke at Johns Hopkins about the value of integrating EMR and claims data to support an ACO’s population health efforts. He is the founding chair of the PHA’s predictive modeling committee. He has authored several white papers and over 25 peer-reviewed publications, including those on ROI studies and predictive modeling.

Michael holds a Master’s and PhD in neuroscience from the University of Connecticut; he completed his post-doctoral fellowship at the University of Chicago.

Additional information is available at: https://www.linkedin.com/in/cousinsm

 

Aerste Howells mugAerste Howells, Senior Vice President, Sales, Matrix Medical Network
As Senior Vice President, Sales, Ms. Aerste Howells is focused on the business, clinical and operational needs of health plans and providers. Through her leadership, Matrix is at the forefront of designing, developing and implementing innovative service solutions to meet those needs.

Ms. Howells joined Matrix in 2011 as vice president, client services for the western region of the U.S. During her two years in the position, she was responsible for business development, client implementations, operations, contract renewals and expansion.

Prior to joining Matrix, Ms. Howells was with Healthways, serving as director, account services, employer and government Division. During her seven years with the company, she was responsible for creating measurable multi-year inception, retention and expansion strategies for employer and government markets.

Ms. Howells has a Bachelor of Arts degree in Marketing and Communications from Brigham Young University.

 

Wold_Heidi MugHeidi Wold, MSN, ARNP, ANP-BC, Vice President, Chronic Care, Matrix Medical Network
Ms. Heidi Wold leads Matrix’s chronic care line of business (Care Direct), which includes the development and implementation of a suite of care coordination and medical management products aimed at improving outcomes for chronically ill health plan members in multiple states and residential settings.

Ms. Wold has more than 30 years of progressive leadership experience in the healthcare industry. Most recently, she served as the vice president of operations for Walgreens’ Take Care Health Systems, Consumer Solutions Group. At Walgreens, she oversaw national operations for the retail clinic business and worked to improve profitability/value, enhance provider engagement and expand patient care services including management of targeted chronic conditions.

Prior to joining Walgreens, Ms. Wold held a series of senior/executive leadership positions with United Healthcare. She ultimately served as vice president of clinical operations & chief nursing officer where she led innovative clinical solutions for Medicaid, Medicare Advantage, Commercial and Dual Special Needs populations across 32 states.

Ms. Wold holds a Master of Nursing Administration/Business from the University of Florida and a Post-Master’s certificate in Adult Nurse Practitioner from the University of Tampa. She is also an ANCC board certified adult nurse practitioner.