Identifying high risk populations and segmenting them into groups for intervention allows health insurance plans to prevent individuals from developing medical conditions which ultimately leads to a healthier population, reduced risk for disease, and lower costs of care. TruCare Analytics™ supports this work. It is a population health module of TruCare that uses machine learning to model risk, identify populations, and provide segmentation. Using this actionable information, organizational and provider dashboards outline quality and performance measures as well acute episode and transition risk.
TruCare Analytics mines claims, social determinant, and clinical data in its modeling process. The solution also utilizes certified HEDIS and other measures for performance analysis and individual members’ gap in care identification. By processing and synthesizing large quantities of data into consumable, readable information, the solution enables member population segmentation as well as individual at-risk member identification. Plans can design care programs, prioritize member outreach plans, engage providers, and define programmatic goals. Care managers can have at their fingertips a clear list of needs and risks so they can begin to provide the support needed and potentially prevent a negative health event from occurring.
The TruCare Analytics component integrates with the TruCare platform, and populates individual members’ records with risk, gap-in-care, and other indicators specific to that member. That information then resides in the member’s record for ready access by care managers, or for workflow automation through TruCare’s rules engine capabilities. Plans can define parameters for the Analytics data to automate tasks, referrals, messages, and/or case creation. This streamlines the population health cycle by connecting identification and segmentation with opportunity for intervention. Through both the TruCare platform and TruCare Analytics, plans can measure outcomes and use the findings to further refine their programs to their population’s needs.
TruCare Analytics provides the data needed to oversee and evaluate both clinical and financial risk. When you report outcomes and share the results, including the percentage of your members enrolled in care management programs, this data can be used to decrease utilization and costs.