Information at their fingertips
Centene uses advanced analytics to help improve healthcare outcomes
In 2010, Centene Corp. rolled out its Centelligence platform, a management solution that uses a combination of advanced analytics and algorithms to provide enterprise information capability across all communication channels. Through the use of this solution, Centene is able to identify its high-risk members and deliver actionable data to callcenter representatives, case managers and medical management employees, and our partners—medical providers—to ensure that these members are receiving the appropriate care needed to manage their health.
Centene reaches out to its high-risk members to educate them on their health issues as well as ensure that they are receiving the proper care based on their circumstances. When members call for an unrelated reason, the callcenter representatives are able to view the member’s profile to see what other action items need to be flagged.
Using Centelligence, demographic and medical data that is collected is enhanced through predictive modeling for each member. The use of advanced analytics and predictive techniques enables Centene to intervene through case and disease management with its members—it’s what makes the Centelligence platform so innovative.
Further innovation lies within the way Centene is able to use the data to send automated alerts and updates to its members, physicians, call-center representatives and case managers, which ultimately helps high-risk members achieve better health outcomes.
Centene is not only finding information on its members for internal use, but also is able to share this information with members’ healthcare providers, putting the providers “in the know” about what other interventions have occurred for the member. For instance, Centene can see if a member did not pick up a prescription called in by the healthcare provider.
Of Centene’s 1.5 million members, depending on the region of the country and the underlying healthcare product, between 2% and 10% of the members at any time are case and disease managed due to high-risk conditions. High-risk members often include those with diabetes, asthma, high-risk pregnancies and other healthrelated issues. Currently, 80 cents to 90 cents of every dollar of revenue goes toward medical costs, and often, only a few members drive a majority of the costs for the organization. One objective of the Centelligence platform is to lower these costs compared with competitors, doing so in a way that will keep Centene members healthier. Ultimately, this serves to provide preventive care to Centene members, which in turn improves outcomes and keeps costs down.
The Centelligence platform drives not only the identification of these high-risk members, but it also sends out internal alerts to call-center representatives, case managers and medical management employees. With access to healthcare history on each individual member, Cen- tene is able to contact its high-risk members, either through inbound or outbound calling, Web portal interaction and the IVR system to educate its members on preventive healthcare and intervene to ensure better outcomes.
More than 1,000 internal business users use Centelligence at least once a week, with several hundred using the platform as their primary decisionmaking tool. Separately, thousands of external medical providers use the system each month to assist in their day-to-day interactions with members. Also, there are currently 40 fulltime IT and business partner staff members on the team who work closely with the platform.
Centene has conducted a number of innovative studies to determine the best way to intervene in high-risk pregnancies. Today, they request all pregnant members or the member’s physician to complete a “notification of pregnancy” health-risk assessment and score it using Centelligence, allowing Centene to put its high-risk members into a case-management program designed just for them (StartSmart for Your Baby). Using historical data from prior pregnancies, there have been situations in which Centene uses drug intervention such as the alpha-hydroxyprogesterone caproate (17P) treatment to significantly reduce preterm births and increase the average birth weight of deliveries.
The Centelligence platform is core to Centene’s mission: better health outcomes at lower costs. It helps to identify high-risk members— based on demographic information, lab results, health-risk screenings, medical claims and more—and uses this knowledge to help members manage their health as a means for preventive care.
This solution impacts medical costs—since implementation, more than 40,000 high-risk members participated in case management (about 3% of Centene’s membership) because of identified high-risk conditions. Each month, several hundred thousand medical claims inquiries, eligibility verifications and care-gap alerts have been supported by the system since go-live over Centene’s Web channel. And, with the increasing integration to Centene’s call centers and IVR platform, the solution supports 100% of all IVR transactions and will support all call-center staff this year as they are trained on the new system.
The upgrades Centene has made to its EDW and the Centelligence platform have made identifying high-risk members and communicating with those members efficient and inexpensive. In addition, the mechanisms for outreach have achieved scalability without linear headcount cost increases (as the organization grows geographically and organically, the solution will scale with it). Through the use of these systems, as well as related investments, Centene is projecting double-digit top-line growth and is managing to improve member outcomes and lower overall costs.