In its first deployment of the new platform, BaseHealth is partnering with Sonora Quest Laboratories, Arizona’s leading provider of diagnostic testing and information services. BaseHealth’s platform combines laboratory data with insurance claims data, published clinical research, and other data sources then apply machine learning to prospectively identify patient health risks and suggest appropriate clinical interventions to address those risks. The process can especially benefit MA plans, which receive capitated payments for the care of Medicare beneficiaries and must carefully gauge the risks and costs across a population.
In a recent case study conducted for a population of 10,000 new MA members, BaseHealth utilized Sonora Quest’s laboratory data to identify potential risk and interventions, uncovering incremental additional revenue opportunity of $3.1 million, as well as an opportunity for $1.5 million in accelerated revenue.
“This partnership will enhance wellness advocacy and help empower advanced healthcare solutions,” said David A. Dexter, president, and CEO of Sonora Quest Laboratories. “By utilizing artificial intelligence and predictive RAF analytics, we can assist health plans and Accountable Care Organizations to identify and stratify unknown risk in population health to the specific patient level, to close potential gaps in patient care, and identify opportunities for interventional cost savings.”
Fragmentation in Leveraging Lab Data’s Value in Predictive Modeling
HCOs’ clinical teams have long seen lab results as a valuable source of data for decisions on treatments and prescriptions. However, due in part to organizational siloes and fragmentation, few business and financial teams across HCOs have fully taken advantage of lab data’s value in predictive modeling to develop prospective risk profiles for their patient populations in service of key business objectives such as risk adjustment, quality improvement, and population health management.
By proactively diagnosing and treating emerging health conditions, HCOs can improve patient care while reducing the risk of higher-than-expected costs for health plan beneficiaries. The process can especially benefit MA plans, which receive capitated payments for the care of Medicare beneficiaries and must carefully gauge the risks and costs across a population.
“BaseHealth’s platform helps to ensure MA plans and the providers they work with are reimbursed fairly by identifying previously unrecognized conditions that would warrant an adjustment in the Risk Adjustment Factor (RAF) score that Medicare uses to determine capitated payments for beneficiaries,” said Hossein Fakhrai-Rad, PhD, Founder and President of BaseHealth. “Our platform provides particular value for MA plans that enroll new members with limited historical data at the beginning of each year, allowing these plans to optimize care management and risk adjustment by employing predictive analytics and laboratory data.”