US HealthCenter: Providing Value-Based Care with Advanced Analytics Resolution

Gavin Quinnies, President | CEO, US HealthCenter

With the advent of technology, the healthcare sector underwent a significant transformation towards bettering care delivery. However, as the concern of increased flow of patients and the subsequent cost to manage and provide quality care grew, the need for a holistic population health management solution turned out to be the must-have competency for healthcare providers. This implied that the traditional approach to healthcare was no longer a viable option for effective population health management. Preventive medicine is rising to the top of the heap, vs better treatment of the already ill. Preventive care and follow-up maintenance required proficient analytics and well-trained, certified health professionals outside direct medical providers. Additionally, factors like inefficient analytical management tools and low participation led to care management challenges. USHC coined the phrase “Pre-disease” in the early 2000s as part of their mission to improve people’s health and reduce healthcare costs by providing industry-leading health management science, technology, and advocacy to prevent and manage the disease.

Headquartered in Milwaukee, WI, US HealthCenter is a leading healthcare organization providing services in pre-disease, disease, and post disease periods. The company uses predictive analytics to focus on member participation and adhesion to the health management programs, ultimately improving care.

Prescient Model For Effective Care

US HealthCenter’s analytics platform, PredictiMed™ is a Software as a Service (SaaS) AI-based personalized, predictive medicine analytics, and population health management solution. It is a unique, fully integrated technology suite devised to help set up a healthier lifestyle, all the while raising productivity and lowering total healthcare costs. The robust, scalable, and adaptable predictive software uses algorithms that are scientifically based metrics to collect verifiable, real, or best-evidenced health data. The software identifies the risk level of disease progression and applies the pre-emptive intervention to avert it. “Our predictive model gathers individual information from demographic data, medical history, pharmacy, biometrics, genetics and lifestyle habits and utilizes that information in the form of an intelligent custom experience-based health risk assessment and analysis,” says Gavin Quinnies, President | CEO, US HealthCenter. “It becomes the roadmap for any future diagnosis of the person and helps to identify and reveal the patient risk factors to provide what we call Wholeistic™ care,” he adds.

A predictive software model is a scientific tool which caters to hospitals and providers, insurance plans and brokers, actuaries and re-insurance, self-insured and fully insured employers. The company uses robust, accessible data, confirms its authenticity, aggregates, and analyzes with the help of its statistically validated proprietary software to fetch the most accurate outcomes, with the accuracy of 80-93%, according to the Intel GE Validation Institute.

The PredictiMed™ predictive model has been third party validated by Intel/GE Validation. In February of 2015, the Institute had the opportunity to validate PredictiMed’s™ ability to identify and lower the predisease high-risk level, which may precipitate a higher use of ER and hospital services, in thirteen major disease categories to a lower level where the pre-emptive intervention can be applied and thus reduce the incidence of ER visits and hospitalizations between 80 and 93%, depending on the disease category. Lower back pain outcome was the only disease category, which resulted in a 17% reduction from the critical risk level to a lower, less emergent level. The PredictiMed™ measures events across the population to avoid participant bias, a common and well-understood invalidation, and emphasize ER and inpatient event avoidance.

US HealthCenter provides services to consumers, employers, health plans, health systems, Third Party Administrators, Coalitions and Government institutions, and can be further customized per client need. “From predictive modeling, care navigation, to clinic management, we cover every aspect of population health and wellbeing management,” states Quinnies.

A Multi-Pronged Risk Evaluation Approach

The PredictiMed™ health management system comprises of a Personal Health Dashboard™ (PHD), health coach tracker, corporate health profile, health counts, Sweeper™ medical and pharmacy claims analytics tool, and content management system.

The PHD is a dynamic and comprehensive user portal utilizing a responsive design that provides a seamless, personalized user experience. It incorporates an inclusive health profile and medical history chart with periodic and episodic medical information that can be accessed at anytime and anywhere. Being a safe, encrypted medical site, the PHD has a medical passport with personal, medical, and insurance information, as well as a comprehensive health and wellness management site.

PredictiMed’s™ Health Coach Tracker tool aids practitioners in overseeing interactions with participants such as setting goals, tracking appointments, collecting data on attained and not attained goals as well as billing the payor for encounters. The tracker is also a data mining tool that uses filters to perform searches to a wide array of categories, including participation, demographics, lifestyle categories, disease categories, predisease risk levels biometric test values, Wellcentive™ Score, and many other parameters. This allows for targeted interventional strategies not available on any other platform. The administrative reporting dashboard provides a confidential executive summary report that is based on the analysis of health risks and behaviors.

USHC provides not only the technology, but healthcare advocacy services such as prior authorization, large case management, disease management, predisease management, and lifestyle management benefit enrolment and benefit advocacy. This service line of Wholeistic™ Coaching is significantly different from the traditional multi-specialist and siloed approach prevalent in the industry today. In 2004 USHC recognized this creates an unhappy user and low engagement experiences, and so created the Wholeistic™ Coaching approach. The Company also was asked by a leading health science university to create a coaching certificate program for senior-level students, and so a five-credit course was created in 2010, which is now available online. Because of the use of this science, technology and advocacy approach, USHC is the only organization to be validated for Care Navigation. Validation Institute, an independent, objective, 3rd party organization focused on changing healthcare, validated US HealthCenter and its PredictiMed™ Population Health and Wellness Analytics, Predictive Modelling, Engagement and Care Solution to receive the highest award of recognition in the category of “Care Navigation.” Care Navigation is a sub-discipline of care coordination that aspires to steer patients to the most appropriate and effective clinical provider. According to the Institute, what put PredictiMed™ over the edge was validated analytics leading to pre-emptive interventions that can reduce the incidence of ER visits and hospitalizations between 80 and 93%.

The Health Counts module is an effective incentive tool of the PredictiMed™ ecosystem, acting as the key agent for managing engagement and tracking health behaviors. The health counts module enables clients to create campaigns and activities to motivate participants, ultimately ensuring tracking group participation progress.

From medical or pharmacy claim events, searching for trends, measuring success, to evaluating expenses, and comparing different segments of the population, these are managed by the Sweeper™ claims analysis tool. Whereas, the content management system module further allows for customization of certain content visible to users on their PHD.

From a technology standpoint, US HealthCenter harnesses a multi-pronged approach that aids the predictive model to identify the onset of a disease before symptoms by combining objective and subjective data. It then uses proprietary analytics to identify risk burden-potential and cost avoidance or exposure for each condition, ultimately providing savings opportunity per at-risk individual. In aggregate, risk managers can see where their risk burden is according to benchmarks financially. This “what-if” analyst can help visualize trends to further identify and improve the existing medical conditions for better health outcomes by helping healthcare organizations focus on proactive care management.

A Turnkey Risk Assessment

The company’s Wholeistic™ health management program comprises a Health Risk Assessment (HRA), a confidential online questionnaire including health and lifestyle habits. Upon completing the survey, participants get a confidential health profile that identifies significant health risks and highlights healthy habits and changes the participant can make to resolve health risks.

US HealthCenter uses a fleet of qualified practitioners to offer remote screening, which includes the integration of results from screenings or physician’s office.

The Wholeistic™ Health Coaching focuses on the individual, patient-centric approach and offers each participant an opportunity to set goals for disease management, self-care, and lifestyle management for physical and mental well-being. Further, users can follow their incentive progress to easily understand the rewards they have earned as a result of their wellness participation and health outcomes.

The Road Ahead

US HealthCenter’s state of the art product suite has earned industry accolades by significantly reducing healthcare costs. The company serves a broad spectrum of clients, such as employers, government, manufacturing, healthcare providers, and more.

For the days to come, US HealthCenter will continue to focus on the identification and health management of individuals in the pre-disease/pre-symptomatic state with its PredictiMed™ analytics platform to get ahead of the later stage illness curve that drives higher costs and poor outcomes.

Using these risk management tools, the company has partnered with providers, employers, and insurance brokerage firms to create self-funded insurance offerings ‘in a box.’ These offerings leverage programs that cost less to buy, as well as reducing the risk of buying expensive services. This two-pronged approach has made a huge difference and is getting attention from the stop-loss market.

In summary, USHC has taken health risk analytics to a new level using a proprietary best-evidenced third-party validated scientific process that analyzes disease risk, claims, provider performance, future forecasts, and value-based reimbursement with significant accuracy in identifying and preventing major medical costs.

With the mission to improve people’s health and reduce healthcare costs by providing industry-leading health management science, technology, and advocacy to prevent and manage diseases, US HealthCenter will continue to disrupt the healthcare space with its best-of-the-breed services.