Predictive Modeling and Disease Management - ：管理预测模型和疾病—.ppt

Using Predictive Modeling to Target Interventions Barry P. Chaiken, MD, MPHChief Medical OfficerABQAURP - PSOS Overview Cost and Quality Trends Disease Management and Modeling Predictive Modeling Fundamentals Accuracy of Models - Case Study Change Per Capita In Health Care Spending and GDP Growth in Per Enrollee Premiums and Benefits Drivers of Care Management 50% - preventive care 30% - lack recommended acute care 40% - lack recommended chronic care 30% - receive contraindicated acute care 20% - receive contraindicated chronic care Recommended Care and Quality Varies Health Care Costs Concentrated in Sick Few Overview Cost and Quality Trends Disease Management and Modeling Predictive Modeling Fundamentals Accuracy of Models - Case Study DM Defined “Knowledge-based process intended to improve continuously the value of health care delivery from the perspectives of those who receive, purchase, provide, supply and evaluate it.” --James B. Couch, MD DM Criteria Specific High dollar and volume Preventable complications Short time frame for results Treatment variability Extensive patient non-compliance Practical guidelines Measurable quality metrics DM Processes Identify patients Develop therapeutic programs Improve outcomes Achieve acceptable cost levels Provide evidence based care Spectrum of Care Risk Measurement Pyramid Overview Cost and Quality Trends Disease Management and Modeling Predictive Modeling Fundamentals Accuracy of Models - Case Study Predictive Modeling Defined Use of clinical information available for all members of a population to predict future healthcare needs, overall or for specific types of services. Reasons for Predictive Modeling Existing high utilization by the few Uses available data to identify high-risk Allows intervention early in disease cycle Enhances case and disease management Predictive Modeling Focus Case management targeting Identify persons for care programs Disease management risk stratification Intensity tier