Predictive modeling meets reality

Predictive modeling is an emerging discipline that health plans use to identify members who are likely to become ill soon and are therefore likely to cost the plan a lot of money. The objective is to manage these patients prospectively to minimize expensive events and conditions. Predictive modeling isn’t trivial –it involves data scrubbing and sophisticated data mining.

But it turns out that making accurate predictions is only half the battle. According to Howard Brill, manager of medical informatics at Monroe Plan for Medical Care, Inc., as quoted by the Healthcare Intelligence Network:

One of the major challenges we’ve had is communicating what that information means to our nurse case managers. There is a very strong pull by nurse case managers to focus attention on the sickest patients. These are not necessarily the individuals on whom they have the greatest impact.

It’s another example of how a systematic approach is necessary to achieve cost and quality improvements. Well intentioned individuals acting in a vacuum or sophisticated modeling techniques aren’t effective on their own.

April 25, 2005

2 thoughts on “Predictive modeling meets reality”

  1. Pedictive Modeling will revolutionize cost containment among payers and improve clinical outcomes by stratifying members for appropriate and timely disease and complex case management interventions.

  2. Very true.Ultimately, end users will want to process the information to recommend appropriate steps. The predictive model’s capabilities together with intervetion strategies should reach synergy and “fuel” one another. Only then will the maximum benefit be realized.

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