Delivering Actionable Insights on Population Risk to Improve Health Outcomes and Reduce Healthcare Costs

摘要

In this paper, we describe an approach to use data analytics, clinical domain knowledge, and automated workflows to deliver actionable insights to Medicaid programs and other overseers of population health. Modularized algorithms are developed in major areas to estimate population risk and evaluate the performance of Managed Care Organizations (MCOs). Clinical expertise orchestrates the algorithms into re-usable analytic flows that can answer specific and complex questions. The results of individual algorithms and/or the analytic flows can provide actionable insights and recommendations for improving health outcomes and reducing healthcare costs.