IntegerHealth‒A Revolutionary Healthcare Technology Company
IntegerHealth is a healthcare analytics and warehousing company that quantifies healthcare outcomes for insurers and employers‒something that no one else does.
We put a $ & ¢ value on each outcome, generating actionable analytics that drive down healthcare costs while improving the quality of care for health plans, wellness programs and workers' compensation.
Your Problem
You know to the penny what you're paying for healthcare, the claims that you pay to doctors and hospitals.
But you don't know what you’re getting in return for those claims dollars.
IntegerHealth Difference
Today you measure the return for your healthcare dollars in terms of “quality,” but that’s a qualitative measure, not a quantitative one, that focuses on process compliance‒what a doctor did, or didn’t do‒or whether the patient “liked” the provider.
The input into the healthcare equation are the claims dollars that you pay. What you need is a way to quantify the output in dollars too so that you can compare the two and calculate your return; and you need to measure what really matters‒the outcome to the patient. Did the patient get better? And if so, how much did it cost and how long did it take?
That's what IntegerHealth does.
How?
IntegerHealth quantifies healthcare outcomes, combining cost and quality into a single $ value across providers, diagnoses, plans, programs and treatment patterns. Now the input into the healthcare equation‒the claims dollars‒can be compared to the output‒the patient’s outcome. By measuring outcomes, we calculate ROIs and generate actionable analytics‒Driving down healthcare costs while improving the quality of care.
We have two ways of quantifying outcomes depending on the data available to us:
Claims + Absence Costs‒When we have the medical and pharmacy claims and an employer's HR absence records we calculate the risk-adjusted total costs (claims + absence) to get an employee back to work and/or keep them there. We use this solution to quantify the employee outcomes for employers that self-insure their health plans and workers' compensation programs; and we also use it with workers' compensation insurers and TPAs, who can substitute the lost wage indemnity payments to the injured employees for the absence costs.
Claims per Heathy Day‒When we have just the claims, we calculate the risk-adjusted claims per healthy day. Instead of asking how much it costs, and how long it takes, to get an employee better and back to work, we ask how much it costs in claims per day to keep someone healthy. We use this solution for health insurance companies and TPAs, Medicare Advantage plans (which in addition to all the other uses, can use this solution when structuring their CMS bids), state and other multi-employer health plans, ACOs and provider groups taking on risk, and when measuring the outcomes of the dependents under an employer health plan.
When You Can Quantify the Outcome…
When you can quantify the outcome, you can do things that you could never do before to drive down your healthcare costs while improving the quality of care. See the case study on the “Resources” page on how our analytics drove down the City of Fort Worth's costs 23%!
Rank Based on Outcome Achieved‒Who are the best PCPs treating diabetes or the best surgeons for knees? Are you getting better outcomes by sending back patients to chiropractors or physical therapists? Which case managers and workers' comp adjusters are getting the best results, both by diagnosis and overall?
Optimize Plan & Network Design‒Set the provider network to include only the best doctors, or at least eliminate the worst. If you're not in a position to do that, form a narrow network within the existing one of the best providers, or stratify the network by eliminating or decreasing copays and out-of-pocket costs when patients go to the best doctors‒Who will cost less overall and get those patients better care. If you're an employer with a HDHP option coupled with HSAs, contribute to your employees' HSAs when they go to the best doctors.
Steer & Direct Care‒Steer patients to the best providers and treatment patterns through your case managers working with chronically ill and high cost claimants and the PCPs in the network making referrals to specialists and surgeons, which is particularly powerful when an employer has an on-site clinic where most of its employees go as their first stop. You can also give patients the ability to look up the best doctors themselves through a “Find a Provider” tool. In 34 states, a workers’ comp adjuster doesn’t steer care, but can direct it, telling an injured employee which doctor to see.
Population Health & Wellness Programs‒Evaluate your population health and calculate the true ROI on your disease management and wellness programs based on the outcomes that they achieve: The decrease, if any, in the medical and pharmacy claims, and medically-related absence costs, of the participating employees‒anything else is just fluff.
Guided Analytics‒Our proprietary groupers and algorithms analyze the claims to tell a story. Not only what happened, but why?
