David Thompson

Thompson

As an Oklahoman, there are many reasons to be proud of our state, however, being last in terms of health care is not one of them.

A 2018 study by The Commonwealth Fund places Oklahoma dead last in its overall rankings taking into account more than 40 health-care measures.

One way we can make progress is through the use of technology. Predictive modeling and analytics has been a turning point for us as a way to focus in on the health of our members and make a positive impact on their lives while saving money at the same time.

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We’ve all heard of “big data,” but how is it used in a health-care setting? Whether in-house or through a technology partner, health-care organizations can leverage a broad set of data sources, including predictive risks (disease-specific and utilization risks) and outcomes (hospitalizations and ER visits) to understand a population’s state of health and identify care gaps.

For example, we currently use this model to identify potential high-risk members, and more importantly, predict, intervene on, and prevent complex and avoidable cases. Through several years of implementation, we’ve decreased the total number of ER events by 8 percent from 2015 to 2017.

These insights have improved health outcomes for thousands of members who received care proactively and in lower-cost settings. Additionally, savings generated from this model have been used to provide members with a rich benefits package over a range of products to ensure Oklahomans find a plan that fits their unique needs.

Another interesting technology solution is the use of video conferencing in a health-care setting. For instance, we’ve recently partnered with Synzi to use their virtual care platform to securely connect members and case managers in different locations for hospital discharge, ensuring the member’s care can be coordinated and all involved are on the same page.

This technology allows for real-time collaboration to provide a clear path of care with the ultimate goal of reducing re-admissions and confusion on post-discharge care.

Of course, technology can only be as good as how it’s implemented, so the key for these technology solutions to work is a focus on high-touch care.

If, in the first predictive modeling example, a member is identified as high-risk, it’s best to reach out to them directly to discuss a plan or identify areas where the member may be struggling. If a member is having trouble staying compliant on their medications, we work with them to identify what is causing the roadblock and help them find a solution.

Likewise, for the virtual consults, if we can provide direct access to case managers for the member, we can get in front of costly medical issues and place them on a path to improved health.

As a state, payers and providers can work together to leverage technology and provide better service to patients, which improves healthcare overall and provides value for Oklahomans.

We can be a leading state in innovation and in improved health-care outcomes. We need to focus our combined efforts and work together.

J. David Thompson is senior vice president and chief operations officer at GlobalHealth, an Oklahoma-based health insurance provider.

The views expressed here are those of the author and not necessarily the Tulsa World. To inquire about writing a Business Viewpoint column, email a short outline to Business Editor Colleen Almeida Smith at business@tulsaworld.com.

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