A highly successful disease management and chronic care solution begins with a highly granular, disease-specific understanding of each member. Precisely who from a broader member patient population needs to be engaged and why? Is their disease newly diagnosed, unstable, or complicated by comorbidities? Are they showing signs of increasing risks for complications or admissions? Are they seemingly unable to access the help that they may need to avoid acute deterioration in their medical condition?

MedAssurant understands the importance of these issues. This is why MedAssurant has developed and applies truly industry-leading medical data analysis processes to examine member encounter patterns, medication data, claims entries, laboratory orders and results, procedural data, durable medical equipment purchases, CMS member data, risk score status, and a host of other data sets. These analyses result in not only the identification of each member’s current medical conditions and utilization patterns, but also their changes over time. Further still, these analytical processes even facilitate the revelation of diagnoses that may not yet be otherwise fully identified, evolved or documented. As a result, MedAssurant’s patient and disease identification processes go far beyond simply claims data screening to provide an advanced, insightful evaluation of the patient’s entire medical picture.

Similarly, the CCS Advantage™ ISAP™ member stratification process goes far beyond separating populations into oversimplified groupings. In fact, MedAssurant’s stratification processing enables stratification specificity that segregates patient disease or comorbidity groups into not three or four sub-classifications and intervention sets, but hundreds of differentiated stratification and care plan combinations. This specificity is critical to direct the intelligent application of the right resources, education, intervention, communication, and support to the right patients.

With patients’ disease status identified and stratified appropriately, prioritization becomes key. Whereas two patients may have otherwise identical disease conditions and levels of acuity at a point in time, one patient may be stable in their condition while the other patient may be rapidly deteriorating and in need of immediate intervention and support. For this reason, the CCS Advantage™ ISAP™ member prioritization process examines rates of change in patient disease condition acuity, utilization, and comorbidity. This disease condition “velocity” is highly valuable in pinpointing who is at imminent risk within a population.