In­for­ma­tion at their fin­ger­tips

Cen­tene uses ad­vanced an­a­lyt­ics to help im­prove health­care out­comes

Modern Healthcare - - Special Feature - Jerry

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.

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