Challenge

Primary Health Medical Group practice participating in downside risk arrangements lacked the technology needed to efficiently manage patients care and identify underlying cost & utilization drivers. The organization, like many others looking to procure technology, was faced with the dilemma of purchasing an Off-the-Shelf (OtS) product or bootstrapping a homegrown solution. The challenge was deciding between a lesser of two evils: (1) Invest in a product that solves only 80% of the needs, OR (2) run the risk of long delays and budget overruns often associated with customized solutions.

Solution

Needing a population health management solution relatively quickly and not wanting to purchase features that weren’t needed, PHMG partnered with Royal Jay to develop a “Customizable” Off-the Shelf solution using the Inflight Cloud platform as a foundation to springboard the development.

Outcome

Inflight Cloud’s framework, equipped with modern capabilities, made it possible for the organization to deploy a fully customized population health management data and analytics solution in a fraction of the time traditional enterprise data warehousing, visualization and reporting projects (e.g.,data platform, ingestion pipelines, transformation engines, identity management, visualization & reporting, predictive analytics, etc.)

In less than six months, the organization had an end-to-end solution for processing and managing data, plus other essential capabilities needed to effectively manage their patient population, to include:

• Master patient indexing
• Provider attribution
• 360-degree patient profiling
• Risk stratification
• Risk adjustment
• Suspect & recapture coding insights
• Provider scorecards
• Leakage & retention analytics
• Care gap closure insights
• Cost & utilization analytics

Approach

• Our teams worked collaboratively to define concepts, purpose, and parameters to drive inclusion and exclusion of data elements for a shared understanding of performance insights.
• We worked through common & complex challenges in the aggregation of claims data and medical concepts.
• We proactively took steps to apply a consistent process to arrive at the right aggregation for the right purpose, ensuring scalability and flexibility for future needs.
• Ultimately deployed a comprehensive data & analytics solution – including common clinical and shared claims data model, data connect workflows, and data enrichment mechanisms; all designed with the intent of taking disparate healthcare data and turning it into a business intelligence and decision-making capabilities for the organization.