Enabling personalized healthcare at scale
The Big Picture
A fortune 100 health and well-being company partnered with Fractal to help deliver personalized and coordinated health care experience for its medicare members. The solution was deployed on the cloud, powering a new healthcare management platform that supports integrated care for its members.
The client was faced with the challenge of having isolated clinical models for critical and primary healthcare, home care, and telehealth. They needed a coordinated healthcare platform offering a personalized care plan for each member, leveraging all existing clinical models and tying them to the right health actions.
Transformative Solution
The client has multiple clinical models to predict acute IP admits, high-cost members, chronic condition progression, readmissions, ER visits, etc. and intervention plans for these models to manage members’ health. However, these tailored interventions didn’t talk to each other, failing to provide a consolidated view of the members.
Fractal co-developed an end-to-end care management platform that could identify and prioritize the members with care needs and recommend the right action. The platform made it simple to understand the health actions required or the current interventions to make the healthcare experience more personalized for the consumer. The new solution allowed the multidisciplinary care team to identify the right members, get a deeper understanding of member’s care needs, and drive the right healthcare interventions.
Platform for unified member experience
The platform was built on five pillars to give a unified experience to each member:
- Stratify: Medicare member cohorts were identified based on their clinical needs like advanced illnesses, chronic conditions, overall health factors, etc.
- Identify: To understand which members needed what kind of care, predictive models, and triggers were identified. Each of the models and triggers was continually enhanced between engine enhancement versions. These models and triggers were productionized end-to-end and incorporated into the platform.
- Prioritize: Gaps in care for each member were identified and prioritized for every member. A holistic framework was developed to prioritize identified members based on their care needs, driven by future costs and utilization.
- Personalize: To provide a personalized experience, member details, preferences, past touchpoint details, and business rules like (do not disturb, call at the specific time, etc.) were captured.
- Roster: A systematic approach was given to the solution with rosters shared with caregivers and care managers with regular monitoring of the services.
A continuous feedback loop was created to support the enhancement of the model and improve the performance of the solution.
The implementation of this solution helped the client to collaborate seamlessly, by offering a single, central view of each member’s clinical history and an insight into different factors like social, lifestyle, and environmental, impacting the member’s health.
The Change
Everybody wants faster and better results. Reducing time and enhancing consumer experience and outcomes are the goals of automation. These objectives became a reality with a highly modular and scalable platform, that enabled continuous enhancements to analytical components and rules.
- The solution removed siloed operations and enabled coordinated and personalized care delivery at scale.
- The solution can identify 40K new members every week for care interventions.
- Multiple datasets were engineered to create a member 360 on the cloud, enabling to scale efficiently and improve the solution further.
- It led to members having a positive perception of their health, provider, and payer, building their confidence.
- With improved access and quality of care, responsiveness, chronic condition management, customer service, and preventive care, the client saw improved Star ratings.
The drive towards integrated care was important to deliver the best health care service to members. The platform brought in a unified experience, connecting members and the healthcare team in a simplified manner. It not only led to improved satisfaction levels, higher number of healthy days for the members, but also to improved understanding of healthcare needs for each member.