Proving the Business Case for the Internet of Things

BaseHealth predictive analytics mine clinical data

Steve Rogerson
January 8, 2019
BaseHealth has introduced a predictive analytics platform that mines clinical laboratory data, helping healthcare organisations (HCOs) improve population health, boost quality scores and optimise risk adjustment.
The California-based predictive health analytics company empowers health systems and Medicare Advantage (MA) plans to manage proactively rising risk within populations.
Available for HCOs across the USA, the platform combines laboratory data with insurance claims data, published clinical research and other data sources, then applies machine learning to identify patient health risks prospectively and suggest appropriate clinical interventions to address those risks.
By proactively diagnosing and treating emerging health conditions, HCOs can improve patient care while reducing the risk of higher-than-expected costs for health plan beneficiaries. The process can especially benefit MA plans that receive capitated payments for the care of Medicare beneficiaries and must carefully gauge the risks and costs across a population.
"BaseHealth's platform helps to ensure MA plans and the providers they work with are reimbursed fairly by identifying previously unrecognised conditions that would warrant an adjustment in the risk adjustment factor (RAF) score that Medicare uses to determine capitated payments for beneficiaries," said Hossein Fakhrai-Rad, president of BaseHealth. "Our platform provides particular value for MA plans that enrol new members with limited historical data at the beginning of each year, allowing these plans to optimise care management and risk adjustment by employing predictive analytics and laboratory data."
HCOs' clinical teams have long seen lab results as a valuable source of data for decisions on treatments and prescriptions. However, due in part to organisational siloes and fragmentation, few business and financial teams across HCOs have fully taken advantage of lab data's value in predictive modelling to develop prospective risk profiles for their patient populations in service of key business objectives such as risk adjustment, quality improvement and population health management.
In its first deployment of the new platform, BaseHealth is partnering with Sonora Quest Laboratories, an Arizona-based provider of diagnostic testing and information services.
In a recent case study conducted for a population of 10,000 new MA members, BaseHealth used Sonora Quest's laboratory data to identify potential risk and interventions, uncovering incremental additional revenue opportunity of $3.1m, as well as an opportunity for $1.5m in accelerated revenue.
"This partnership will enhance wellness advocacy and help empower advanced healthcare," said David Dexter, president and CEO of Sonora Quest Laboratories. "By utilising artificial intelligence and predictive RAF analytics, we can assist health plans and accountable care organisations to identify and stratify unknown risk in population health to the specific patient level, to close potential gaps in patient care and identify opportunities for interventional cost savings."
As the first predictive health analytics platform that is evidence-based and data-driven without reliance on retrospective claims and ICD data, BaseHealth says it takes the guesswork out of risk and population health management and puts science in the driver's seat.
"BaseHealth is proud to deliver a pioneering solution that couples laboratory data with advanced analytics to improve value-based care management and proactive risk adjustment," said Fakhrai-Rad. "Our solution has demonstrated the efficacy of using lab data only to identify risk and opportunities for RAF score adjustment in new member MA populations for whom there is insufficient medical history available through claims."